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COMPEND 


DENTAL  PATHOLOGY 


THERAPEUTICS. 


Henry  H.  Burchard,  M.D.,  D.D.S, 

SPECIAL     LECTURER    UPON    DENTAL    PATHOLOGY 
AND   THERAPEUTICS, 

PHILADELPHIA  DENTAL  COLLEGE. 


PHILADELPHIA  : 

The  S.  S.  White  Dental  Mfg.  Co. 

1896. 


S5 


N^ovau  \ 


Copyright,  1896,  by 
The  S.  S.  White  Dental  Manufacturing  Company. 


DEDICATED   TO   THE   MEMORY   OF  THE 
author's   FRIEND, 

5a6.  JE.  (BarretBon,  'B./Ifc.,  /IR.I).,  2).D.S., 

WHOSE   LIFE-WORK   WAS  THE   TEACHING 
OF   PRINCIPLES. 


PREFACE. 

T^HIS  little  volume  is  not  prepared  as  an  aid  to  students 
in  memorizing  answers  for  an  examination  ;  the  end  of 
the  book  would  be   defeated  were   it  used  for  any  such 
purpose. 

In  framing  the  questions  and  answers  an  endeavor  has 
been  made  to  have  each  of  them  represent  a  guiding  prin- 
ciple in  dental  pathology  or  therapeutics.  It  is  essentially  a 
student's  note-book,  to  which  additions  and  details  are  to 
be  made  m  conformity  with  didactic  teachings.  Prepared 
primarily  for  students  attending  his  own  lectures,  the  writer 
ventures  the  hope  that  the  book  may  be  found  useful  to 
dental  students  in  general,  and  incidentally  to  other  teachers. 

H.  H.  B. 


CONTENTS. 

PAGE 

General  Principles i 

Hyperemia  or  Congestion 13 

Inflammation iS 

Bacteria          .        . 19 

Fever 24 

Septicemia  and  Pyemia 27 

Embolus  and  Thrombus 28 

Necrosis 28 

Regeneration 29 

Dental  Histology 30 

Dental  Anatomy 36 

Dental  Embryology ^4 

Malformations  of  the  Teeth  .        .        .        .        -  49 

Primary  Dentition So 

Eruption  of  the  Permanent  Teeth        ...  55 

Diseases  of  the  Enamel .57 

Green-Stain 58 

Diseases  of  the  Dentine  and  Pulp        ...  59 

Dental  Caries .  67 

Therapeutics  of  Caries      .        .        .        .        .        .71 

Hyperemia  of  the  Pulp — Grades  and  Effects    .  75 

Inflammation  of  the  Dental  Pulp        .        .        .  77 

Pulp-Capping 79 

Extirpation  of  the  Pulp 82 

Suppuration  of  the  Pulp 88 

Diseases  of  the  Pericementum         ....  92 

Calcic  Inflammation  and  Calculi  ....  109 
Pyorrhea  Alveolaris          .        .        .        .        .        .111 

Erosion  of  the  Teeth 120 

Dental  Pharmacology  and  Materia  Medica       .  121 

Dental  Medicine  Cabinet 130 


CoMPEND  OF  Dental  Pathology  and 
Therapeutics. 


1.  What  is  patholog-y? 

It  is  the  science  which  treats  of  the  natural  his- 
tory of  disease;  it  is  morbid  biology.  The  word  is 
derived  from  the  Gr.  pathos,  disease,  and  logos,  a 
discourse  or  treatise. 

2.  What  is  biology? 

It  is  the  science  which  treats  of  life :  derived  from 
the  Gr.  bios,  life,  and  logos. 

3.  What  is  meant  by  life? 

It  is  a  distinctive  and  persistent  energy  always 
associated  with  a  substance  called  protoplasm. 

4-     What  is  protoplasm? 

The  physical  basis  of  life.  Its  exact  chemical 
composition  is  unknown.  It  contains  C,  O,  H, 
and  N,  combined  with  S  and  P,  in  enormous 
molecules. 

5.     What  are  cells? 

Small  masses  of  protoplasm  which  exhibit  the 
sum  of  phenomena  called  life. 

,6.     What  are  these  phenomena? 

They  are  called  the  functions  and  properties  of 
cells.     They  are  irritability,  contractility,  and  the 


2  COMPEND    OF 

power  of  growth-maintenance  and  reproduction, 
together  Avith  the  nutritive  functions  of  secretion, 
digestion,  and  excretion. 

7.  What  is  the  anatomical  composition  of  a  typ- 
ical cell? 

It  has  a  definite  boundary  outlining  its  form, 
called  the  cell-wall.  A  small  spherical  body  occu- 
pies some  portion  of  the  cell;  this  is  the  nucleus; 
surrounding  the  nucleus  and  inclosed  by  the  cell- 
wall  are  what  are  known  as  cell  contents.  The 
cell  contents  are  traversed  by  a  line  reticulum,  the 
nucleus  by  a  more  dense  one.  The  substance  of 
the  net-w^ork  is  by  some  supposed  to  be  the  proto- 
plasm, the  fluid  or  semi-gelatinous  substance  oc- 
cupying the  net-work,  the  pabulum. 

8.  What  are  the  necessary  conditions  for  the 
proper  performance  of  cell  function? 

The  cell  must  inherit  fro;ii  its  parent  the  stand- 
ard measure  of  vitality.  It  must  receive  a  proper 
food  supply;  it  must  be  maintained  at  the  proper 
temperature,  and  its  waste  products  must  be  re- 
moved. 

9.  What  are  the  conditions  and  offices  of  foods? 

They  are  in  solids,  liquids,  or  gases.  Cell  func- 
tion is  largely  manifested  in  a  process  of  oxida- 
tion. A  supply  of  the  gas,  oxygen,  is  therefore 
necessary.  Water  is  necessary  as  a  circulating  me- 
dium, and  to  hold  the  various  solids  in  solution, 
which  are  required  for  the  nutrition  of  the  cells. 

10.  What  are  the  observed  chemical  phenom- 
ena attendant  upon  cell  life? 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.    3 

Materials  of  knoAvn  and  complex  chemical  com- 
position are  taken  into  the  cell  as  food;  these  are  in 
part  built  into  still  more  complex  form  by  the  cell 
becoming  part  of  it;  substances  are  discharged 
which  have  a  more  simple  composition  than  the 
food.  The  chemical  action  through  which  this  de- 
composition is  brought  about  is  oxidation,  which  is 
manifested  by  the  production  of  heat. 

II.  Under  what  heads  may  the  conditions  of 
life  be  placed? 

Under  innervation;  in  the  cell,  the  power  resid- 
ing in  that  body  of  performing  function.  Circula- 
tion; including  the  proper  food  supply,  and  the  re- 
moval of  waste  products.  Respiration  includes  the 
supply  of  oxygen  and  the  removal  of  the  carbon 
dioxid. 

.12.  In  what  three  ways  is  vital  energy  mani- 
fested? 

In  nutritive,  functional,  and  reproductive  action. 
The  first  includes  the  three  conditions  of  life.  The 
work  or  office  of  the  cell  is  embraced  in  the  sec- 
ond; the  power  of  generating  bodies  similar  to 
itself  in  the  last. 

13.  What  term  do  we  apply  to  the  normal  per- 
formance of  the  functions  of  cells? 

Health, — vital  equilibrium,  or  a  condition  of  ease. 

14.  What  term  is  applied  to  their  abnormal  per- 
formance? 

Dis-ease,  dis-health,  or  a  disturbance  of  vital 
equilibrium. 

15.  How  are  diseases  divided? 


4  COMPEND    OF 

Into  functional  and  structural.  Structural  dis- 
eases are  those  in  which  there  is  a  demonstrable  al- 
teration in  the  structure  of  the  cell.  Functional 
diseases  are  those  in  which  structural  change  can- 
not be  demonstrated,  and  yet  there  is  evidence  Oi 
disturbance  in  one  or  more  of  the  cell  functions. 

1 6.  Have  all  cells  an  equal  resistive  power  to 
the  causes  of  disease? 

No:  some  are  weak,  inheriting  the  weakness 
from  parents,  and  from  a  variety  of  other  additional 
causes  they  yield  to  disease, — that  is,  they  have  a 
predisposition  toward  disease. 

17.  Of  what  importance  is  an  exhaustive  knowl- 
edge of  cell  function  and  structure? 

The  functions  of  any  animal  body  are  comprised 
in  the  functions  of  its  cells. 

18.  What  is  the  difference  between  a  simple  or- 
ganism, such  as  an  amoeba,  and  the  highest  or- 
ganism— man  ? 

The  essential  nature  of  vital  activity  is  alike  in 
both,  but  the  simple  functions  which  are  performed 
by  the  general  body  of  an  aniaba  are  multiplied 
and  elaborated  progressively  in  higher  animals; 
certain  portions  of  the  body  are  outlined  for  the 
performance  of  single  functions.  An  animal  is 
classified  in  the  zoological  scale  according  to  the 
extent  to  which  it  possesses  organs  for  special  func- 
tions. These  functions,  no  matter  how  subdivided, 
may  still  be  included  under  the  three  heads,  inner- 
vation, circulation,  and  respiration.  This  is  the 
tripod  of  life.     (Bichat.) 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.  5 

19.  To  what  systems  in  the  human  body  do 
these  correspond? 

Innervation,  to  all  the  functions  of  the  nervous 
system,  from  the  simplest  reflex  act  to  the  highest 
thought.  Circulation,  to  the  alimentary,  circula- 
tory, and  excretory  systems.  Respiration,  with  the 
pulmonary  system,  including  the  blood-corpuscles 
and  the  organs  in  which  they  are  formed.  It  is  es- 
sential to  health  that  all  three  of  these  functions, 
no  matter  how  subdivided,  be  properly  performed. 
Any  interference  with  either  constitutes  disease. 

20.  What  is  a  collection  of  cells  of  one  type 
called? 

A  tissue. 

21.  What  is  an  organ? 

Organs  are  tissues  of  several  types  built  into  def- 
inite forms,  the  ofQce  of  the  organ  being  the  per- 
formance of  a  distinct  function. 

22.  What  power  is  inherent  in  all  vital  tissues? 
The  power  of  repair  after  injury. 

23.  In  the  study  of  disease  what  elements  are 
first  considered? 

Hereditary  influences,  the  food  supply,  the  vas- 
cular system,  the  nervous  mechanism,  and  excre- 
tion. 

24.  What  knowledge  is  an  essential  preliminary 
to  the  study  of  disease  of  a  part? 

A  familiarity  with  its  anatomy,  both  macroscopic 
and  microscopic,  with  its  embryology,  or  its  mode 
of  origin  and  formation.  Its  physiology  must  be 
known;  that  is,  the  student  should  be  familiar  with 
the  mode  of  performance  of  its  function. 


D  COMPEND    OF 

25.  What  are  the  two  general  classes  of  influ- 
ences affecting  vital  activity? 

Stimulation,  or  agencies  which  tend  to  increase 
activity.     Sedatives,  those  which  decrease  it. 

26.  What  is  the  effect  of  stimulation  upon  cells? 
It  depends  upon  tlie  degree.     A  mild  stimulus  in 

creasciS    the    functional    activity;    over-stimulation 
produces  paralysis  of  cell  function. 

27.  What  is  the  effect  of  sedation? 

A  lessening  of  cell  function,  of  vital  activity;  if 
prolonged,  it  produces  paralysis  of  cell  function 
also.  The  stimulation  or  sedation  may  be  of  any 
of  the  cell  functions. 

28.  What  is  meant  by  etiology? 

It  is  the  science  which  deals  with  the  causes  of 
disease.     (Gr.  cctios,  cause.) 

29.  What  is  meant  by  semeiology? 

The  science  which  treats  of  the  signs  and  symp- 
toms of  disease.  It  is  derived  from  the  Greek  of 
semeion,  a  mark  or  sign,  and  logos. 

30.  What  are  signs  and  symptoms? 

Signs  are  the  objective  evidences  of  disease 
noted  by  the  practitioner.  Symptoms  are  the 
subjective  evidences  elicited  from  the  patient. 

31.  What  is  meant  by  the  pathology  and  mor- 
bid anatomy  of  a  disease? 

Morbid  anatomy  describes  the  changCiS  which 
have  occurred  in  tissues  as  the  result  of  disease; 
pathology  describes  the  vital  actions  through  which 
these  changes  have  been  brought  about. 

32.  What  is  meant  by  the  clinical  history  of  dis- 
ease? 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.    7 

It  is  the  natural  histor}^,  dealing  with  the  first 
evidences  of  disease  and  describing  its  natural  pro- 
gress to  the  termination. 

33.  What  is  meant  by  diagnosis? 

The  discrimination  of  a  disease,  the  determining 
of  its  nature.  It  is  derived  from  the  Greek  dia, 
through,  and  gignosko,  I  know  (gnosis,  knowledge). 

34.  What  is  meant  by  prognosis? 

Foretelling  the  probable  course  and  termina- 
tion of  a  disease.  It  is  derived  from  the  Greek  pro, 
before,  and  gignosko,  gnosis. 

35.  What  is  meant  by  pathogenesis? 

It  deals  with  the  origin  and  development  of  dis- 
ease. Pathos,  disease;  gennao,  I  produce.  It  com- 
prises etiology,  the  science  of  the  causes  of  disease, 
with  pathology,  morbid  anatomy,  and  semeiolog3^ 

36.  What  is  meant  by  therapeutics? 

It  is  the  science  and  art  of  the  treatment  of  dis- 
eases.    Greek  tJierapeucin,  to  take  care  of,  to  heal. 

■Tfy.     How  is  therapeutics  divided? 

Into  rational  and  empirical.  Rational  therapeu- 
tics aims  to  cure  disease  by  removing  its  cause, 
remedies  being  applied  with  a  full  knowledge  of 
their  mode  of  action.  Empirical  therapeutics  ap- 
plies remedies  without  such  knowledge. 

38.  How  may  the  causes  of  disease  be  divided? 
Into  extrinsic,  or  those  which  affect  the  organism 

from  without ;  and  intrinsic,  those  which  have  origin 
Vvathin  the  organism. 

39.  How  may  the  causes  of  disease  be  again  di- 
vided? 

Into  predisposing  and  exciting. 


iS  COMPEND    OF 

40.  What  is  meant  by  predisposing  causes? 
Influences  which  lessen  the  resistance  of  a  part  to 

the  attacks  of  disease.  The  usual  order  of  the  in- 
fluence of  predisposition  is:  i.  Heredity:  defective 
structure  of  a  part,  either  inherited  or  acquired. 
The  defect  may  not  be  discoverable,  except  through 
such  evidence  as  imperfect  function.  Heredity  is 
markedly  shown  in  phthisis,  gout,  cancer,  syphilis, 
asthma.  2.  Existing  disease,  by  lowering  the  vital 
tone,  may  predispose  to  other  disease.  3.  Previous 
disease;  a  part  once  subjected  to  inflammatory  dis- 
turbance has  lessened  vitality.  Immunity  from  dis- 
ease may  be  acquired  through  an  attack  of  the 
disease,  or  by  inoculation.  The  exanthemata  are 
examples  of  this.  4.  Debilitating  influences,  in- 
cluding hereditary  influences.  5.  Temperament. 
6.  Age;  certain  diseases  have  a  predilection  for  a 
definite  period  of  life.  7.  Sex;  anatomical  and 
physiological  differences  of  the  sexes  predispose  to 
certain  disorders.  9.  Occupation ;  for  example,  ex- 
posure to  cold  and  wet  will  predispose  to  rheuma- 
tism, exposure  to  phosphorus  fumes  to  necrosis  of 
the  jaws. 

41.  What  is  meant  by  a  diathesis? 

A  constitutional  predisposition  toward  some  dis- 
ease. 

42.  What  is  meant  by  cachexia? 

The   constitutional   manifestations   of  hereditary 
disease,  such  as  syphilis  or  tuberculosis. 

43.  What  are  exciting  causes  of  disease? 
Those  which  give  direct  origin  to  a  malady. 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.    9 

44.  Under  what  heads  may  they  be  arranged? 
Abnormal  blood-supply;  an  excess  or  deficiency 

in  the  blood  or  of  its  constituents,  including  prod- 
ucts present  as  the  result  of  faulty  excretion;  those 
present  in  consequence  of  the  introduction  of  para- 
sites or  their  products,  or  due  to  faults  of  blood- 
formation.  2.  Abnormal  physical  conditions,  in- 
cluding injuries  from  any  cause  whatever,  acting 
either  froin  without  or  within.  3.  Altered  nerve- 
influence. 

45.  What  is  the  great  clinical  division  of  dis- 
eases? 

General  and  local.  The  first,  those  which  exhibit 
widespread  disturbance;  the  second,  those  which 
afifect  but  a  limited  area. 

46.  Why  is  this  division  delusive? 

Many  local  diseases  are  attended  by  general  dis- 
turbance ;  many  general  diseases  have  a  local  origin, 
a  focus  of  disease. 

47.  What  three  factors  must  be  considered  in 
the  study  of  disease  in  a  part? 

The  condition  of  its  anatomical  parts  and  its 
physiology.  This  includes  a  study  of  the  cells  and 
intercellular  substance  of  a  part;  its  vascular  supply, 
including  any  aberrations  in  the  blood  or  blood- 
vessels, and  the  removal  of  waste  products;  the 
condition  and  action  of  the  nervous  supply. 

48.  What  is  the  primary  consideration? 

The  nutrition  of  the  part,  intimately  associated 
with  the  vascular  supply. 

49.  What  factors  are  first  considered  in  this  con- 
nection? 

The  composition  of  the  blood,  and  its  distribution. 
3 


lO  COMPEND    OF 

50.     What    is   the    normal    composition    of    the 
blood? 

A  viscid,  opaque,  red,  and  sHghtly  alicaline  fluid, 

S.  G.  1055,  and  a  mean  temperature  of  99°  F.  or 
about  37°  C.     It  contains — 

Water,  78.16  per  cent 781 

Dry  corpuscles,  13.50  per  1000 135 

Albuminoids,  7.00. 70 

Fibrin,  0.25 2.5 

Fats,  0.17 1.7 

Extractives,  0.84 8.4 

Earthy  phosphates,  0.03 0.3 

Iron,  0.05 o 


1000 
Its  composition  varies  as  to  time  and  situation. 
Blood  contains  the  supply  of  food,  including  oxy- 
gen, for  the  nourishment  of  the  tissues,  together 
with  waste  products  to  be  eliminated. 

51.  What  is  the  composition  and  ofifice  of  the 
red  corpuscles? 

They  are  oxygen-carriers;  the  body  of  the  cor- 
puscle is  made  up  of  a  reticulum,  in  the  meshes  of 
which  is  contained  hemaglobin,  the  oxygen-carrier. 
Any  deficiency  in  this  substance  is  followed  by 
defective  oxidation,  or  faulty  nutrition  of  cells. 

They  are  present  in  the  ratio  of  about  500  to  i  of 
the  white  corpuscles. 

52.  What  is  an  important  function  of  the  white 
corpuscles? 

The  devouring  of  foreign  bodies  which  gain  ac- 
cess to  the  body. 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       II 

53.  What  is  this  process  called? 
Phagocytosis  (see  under  Bacteria). 

54.  What  is  meant  by  plethora? 

An  excess  of  the  volume  of  blood.  It  may  be 
sthenic  or  asthenic. 

55.  What  is  meant  by  anemia? 

An  increase  of  the  number  of  white  corpuscles  as 
compared  with  the  red.  Anemia  may  be  benign  or 
pernicious;  acute  or  chronic.  Acute  anemia  re- 
sults from  hemorrhage.  Chronic  anemia  may  be 
due  to  repeated  hemorrhage,  as,  for  example,  from 
menorrhagia.  All  debilitating  diseases  may  be  at- 
tended by  anemia;  malaria  is  a  prominent  cause. 
Improper  food-supply  is  a  prolific  source  of  a 
usually  benign  anemia. 

56.  What  abnormal  constituents  of  the  blood 
are  productive  of  disease? 

Waste  products,  retained  in  the  circulating  blood, 
and  which  should  be  excreted;  such  as  urea,  uric 
acid  (urates),  and  other  products  of  tissue  metabol- 
ism, and  an  excess  of  other  waste  products.  The 
waste  products  arising  through  the  action  of  bac- 
teria. 

57.  What  are  these  substances  called? 
Intoxicants  and  poisons. 

58.  What  is  the  most  prominent  cause  of  the 
presence  of  an  excess  of  waste  products? 

Failure  of  the  excretory  apparatus  in  their  elim- 
ination. The  kidneys  are  more  often  at  fault  than 
any  other  organs.  An  increased  production  is  the 
next  cause. 


12  COMPEND    OF 

59.  What  factor  is  next  considered  as  regards 
the  blood-supply? 

The  vascular  mechanism,  including  the  action  of 
the  heart,  blood-vessels,  and  lymphatics. 

60.  What  is  the  usual  method  of  noting  the  con- 
dition of  this  mechanism? 

By  the  pulse.  Noting  the  force,  volume,  and  fre- 
quency with  which  the  blood  is  driven  through  the 
vessels. 

61.  How  is  the  pulse  noted? 

By  pressure  upon  a  superficial  artery  of  sufificient 
size  to  give  a  well-marked  pulsation.  The  radial, 
temporal,  and  facial  arteries  are  those  usually  se- 
lected. 

62.  What  may  be  learned  from  the  pulse? 

The  force,  frequency,  and  regularity  of  the  heart- 
beat; also  the  condition  of  the  walls  of  the  artery. 
The  average  pulse  is  75  per  minute,  which  gives  the 
sensation,  when  felt,  of  a  gradually  and  quickly 
rising  and  subsiding  wave.  It  is  susceptible  to 
changes  of  volume,  frequency,  and  regularity. 

63.  How  are  the  conditions  of  the  pulse  desig- 
nated? 

Full  or  small,  relating  to  volume. 

Hard  or  soft,  relating  to  tension. 

Quick  or  slow,  relating  to  frequency. 

Regular  or  intermittent,  relating  to  regularity. 

Increased  volume,  and  frequency,  are  indicative 
of  a  full  vascular  supply  to  the  organs. 

Smallness  and  softness  to  a  diminished  supply. 

Increased  frequency  is  an  associate  of  smallness 
and  softness,  in  conditions  of  debility. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.        1 3 

Increase  in  frequency,  volume,  and  tension  are 
associates  of  sthenic  inflammation. 

64.  What  local  vascular  conditions  follow  upon 
conditions  of  the  pulse? 

Increase  of  the  heart's  action  is  followed  by  a 
filling  of  the  arteries  and  emptying  of  the  veins.  A 
decrease  of  its  action  is  followed  by  the  reverse  con- 
dition— a  filling  of  the  veins  and  a  diminution  of  the 
blood  in  the  arterial  system. 

Hyperemia  or  Congestion. 

1.  What  is  meant  by  hyperemia? 

It  is  an  excess  of  blood  in  the  more  or  less  dilated 
vessels  of  a  part. 

2.  What  types  of  congestion  are  recognized? 
Arterial,  or  active;  and  venous,   or  inechanical 

hyperemia. 

3.  What  is  active  hyperemia? 

It  is  an  excess  of  arterial  blood  in  a  part,  with  an 
acceleration  of  flow. 

4.  What  is  its  immediate  cause? 
Diminished  arterial  resistance. 

5.  To  what  may  this  be  due? 

~  Fatigue  of  muscular  walls  of  the  artery,  due  to 
overwork  or  injury,  or  the  removal  of  support  to 
which  the  arteries  have  been  accustomed. 

Second,  to  vaso-motor  influences;  the  vaso-con- 
strictor  nerves  are  paralyzed,  or  the  vaso-dilator 
nerves  are  stimulated. 

6.  What  is  the  accompaniment  of  arterial  hyper- 
emia? 

Increased  redness  and  swelling  of  a  part. 


14  COMPEND    OF 

7.  How  is  hyperemia  produced  as  a  reflex? 

The  irritation  of  a  part  is  followed  by  a  constric- 
tion of  the  neighboring  arteries;  if  the  irritation  is 
continued,  the  reflex  is  weakened  and  the  vessels 
dilate. 

8.  What  are  the  symptoms  of  hyperemia? 

An  increase  of  the  functional  activities  of  the 
parts  supplied  by  the  dilated  artery  occurs;  sensa- 
tion and  nutrition  are  increased.  There  is  a  sub- 
jective sense  of  throbbing,  and  the  part  is  reddened. 

9.  What  are  the  results  of  continued  hyperemia? 
Hypertrophy  and  permanent  dilatation  of  the  af- 
fected arteries. 

10.  What  is  its  treatment? 

Removal  of  exciting  cause.  Derivation,  a  draw- 
ing of  the  blood  to  other  parts,  by  means  of  cathar- 
tics, diaphoretics,  and  counter-irritants  applied  at  a 
distance  from  the  affected  part.  Lessening  of  the 
pulse  and  of  nervous  excitation,  by  means  of  arterial 
and  nervous  sedatives. 

11.  Define  these  agents  and  explain  their  modes 
of  action. 

Cathartics  are  agents  which  increase  the  activity 
of  the  bowels;  administered  to  produce  watery  evac- 
uations. Diaphoretics  increase  the  flow  of  per- 
spiration. Diuretics  increase  the  flow  of  urine,  the 
general  volume  of  the  blood  being  lessened  by  all 
of  these  means.  Counter-irritants  are  agents  which 
cause  a  flow  of  blood  to  the  part  where  they  are 
applied.  Vesicants  cause  a  pronounced  irritation, 
producing  a  blister.     Arterial  sedatives  reduce  the 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.   1 5 

frequency  and  strength  of  the  heart's  pulsation. 
All  of  these  measures  tend  to  lessen  the  amount  of 
blood  carried  to  an  inflamed  part  in  a  given  time. 

12.  What  are  the  distinguishing  features  of 
venous  congestion? 

An  increase  of  blood  in  the  dilated  capillaries  and 
veins  of  a  part;  its  motion  diminished. 

13.  What  is  its  cause? 

Usually,  mechanical  interference  with  the  re- 
turn of  the  blood  through  the  veins;  it  is  called,  in 
consequence,  mechanical  hyperemia. 

14.  How  are  the  causes  divided? 

Into  those  which  lessen  the  propelling  force,  the 
vis  a  tergo;  and  those  which  form  an  impediment  to 
the  return  of  the  blood  to  the  heart,  introducing  a 
vis  a  -f route. 

15.  What  are  the  effects? 

An  accumulation  of  waste  products  in  the  re- 
tained blood,  diminished  nutrition  of  the  part,  and 
serous  effusions  into  the  lymph-spaces. 

16.  What  is  its  treatment? 

Support  to  the  dilated  veins;  the  means  of  secur- 
ing the  support  will  depend  upon  its  anatomical 
situation.  Bandages,  massage,  and  elevation  of  the 
congested  part  are  indicated.  Astringents  are  em- 
ployed in  some  situations. 

Inflammation. 

I.     What  is  inflammation? 

The  succession  of  changes  which  take  place  in 
a  living  tissue  as  the  result  of  some  kind  of  injury, 


l6  COMPEND    OF 

provided  this  injury  be  insufficient  to  immediately 
destroy  its  vitality.     (Sanderson.) 

It  is  essentially  a  local  tissue  degeneration,  com- 
bined with  pathological  exudations  from  the  blood- 
vessels, followed  sooner  or  later  by  tissue  prolifera- 
tion, leading  to  regeneration  or  hypertrophy. 
(Ziegler.) 

2.  What  are  its  causes? 

The  presence  of  an  irritant  acting  locally  and 
with  a  greater  intensity  than  productive  of  hyper- 
emia. 

3.  Under  what  three  heads  is  the  process  of 
simple  inflammation  described? 

Changes  in  the  blood-vessels  and  circulation. 
Exudation  of  fluid  and  of  blood-corpuscles  from 
the  vessels. 

Changes  in  the  inflamed  tissues. 

4.  Describe  the  process  as  seen  under  the  mi- 
croscope. 

A  transient  contraction  of  arterioles  is  followed 
by  their  dilatation.  The  blood  flows  with  increased 
velocity  through  the  vessels.  Soon  a  disposition 
is  exhibited  by  the  white  corpuscles  (leucocytes)  to 
cling  to  the  walls  of  the  small  veins.  It  is  around 
these  vessels  that  the  phenomena  of  inflammation 
are  observed.  The  leucocytes  appear  to  cling  to  the 
walls  of  the  venules,  which  seem  to  exhibit  an 
affinity  for  them.  They  mass  in  such  numbers  that 
the  central  blood-stream  is  obstructed.  An  exuda- 
tion, rich  in  albumin,  is  nourcd  from  the  vessels 
into  the  tissues,  and  next  leucocytes  may  be  seen 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.        1/ 

passing  through  the  walls  of  the  veins  (diapedesis). 
The  cells  accumulate  in  the  tissues  about  the  ves- 
sels. Some  of  them  are  taken  up  by  the  lymph- 
stream. 

The  subsequent  history  depends  upon  the  nature 
of  the  inflammation. 

5.  What  are  the  symptoms  of  inflammation? 
Redness,  heat,  pain,  and  swelling,  with  altered 

function  of  the  inflamed  part.  Any  of  these  symp- 
toms, except  the  last,  may  be  absent. 

6.  What  are  the  causes  of  these  phenomena? 
The  presence  of  an  increased  amount  of  arterial 

blood  causes  redness  and  heat.  The  swelling  is 
caused  by  the  exudation:  the  pain  is  probably 
caused  by  pressure  upon  nerve-filaments. 

7.  What  are  the  terminations  of  inflammation? 

Resolution,  or  a  gradual  cessation  of  the  symp- 
toms ;  necrosis,  or  a  death  of  tissues  in  the  inflamed 
territory;  chronic  inflammation,  or  a  persistence  of 
inflammatory  action,  Avith  an  absence  of  acute 
symptoms. 

8.  What  is  the  treatment  of  inflammation? 
Removal  of  the  exciting  cause  and  reestablishing 

the  equilibrium  of  the  circulation. 

9.  What  is  the  principle  of  abortive  treatment 
in  acute  inflammation? 

The  removal  of  the  stagnation  in  the  vessels  of 
the  inflamed  area. 

10.  HoAV  is  this  accomplished? 

By  removing  the  cause  of  its  stagnation,  remov- 
ing the  blood  from  the  venous  side  of  the  area. 

4 


lo  COMPEND    OF 

Experiments  have  shown  that  lessening  the  amount 
of  blood  carried  to  the  part,  though  a  depression 
of  the  heart's  action,  is  less  effective,  as  also  are 
means  called  derivation,  except  in  the  very  early 
stages  of  inflammation. 

11.  How  is  the  first  object  accomplished? 
By  local  blood-letting. 

12.  How  is  this  done? 

By  means  of  leeches,  scarification,  and  wet  cups. 

13.  Describe  these. 

The  leech  is  applied  beyond  the  margin  of  the 
inflamed  area;  by  means  of  its  tripartite  toothed 
jaws  it  effects  an  opening  through  the  slcin,  and  bv 
means  of  its  sucker  abstracts  blood.  The  Swedish 
leech  removes  about  half  an  ounce  of  blood;  the 
American  leech  half  as  much.  The  operation  of 
scarification  consists  of  making  a  series  of  inci- 
sions with  a  lancet,  producing  a  flow  of  blood 
which  tends  to  unload  the  engorged  vessels.  Wet 
cupping  is  done  by  drawing  a  volume  of  blood  by 
means  of  dry  cups,  and  scarifying  the  cupped  areas. 
Blisters  and  counter-irritants  (applied  at  a  distance) 
are  milder  means  of  producing  the  same  effect  in  a 
less  degree. 

14.  What  are  the  means  and  measures  adopted 
for  combating  inflammation  called? 

Antiphlogistic  treatment. 

15.  What  is  the  most  usual  of  these  means,  and 
what  end  does  it  serve? 

Applications  of  cold.  By  contracting  the  blood- 
vessels it  leasens  the  symptoms  of  inflammation. 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.   1 9 

"  i6.  What  agents  are  administered  in  the  early- 
stages  of  inflammation  to  overcome  the  vascular 
symptoms? 

Ergot  and  arterial  sedatives,  aconite,  veratrum 
viride,  and  gelsemium. 

17.  What  effect  have  these  agents  after  vascular 
stagnation  occurs? 

They  increase  the  stagnation.  Administered 
after  local  blood-letting  they  lessen  the  volume  of 
blood  carried  to  the  inflamed  area. 

18.  When  are  hot  applications  made? 

W^hen  the  temperature  is  low,  the  circulation 
sluggish,  and  the  color  of  the  parts  dusky. 
Warmth  dilates  the  blood-vessels;  heat  contracts 
them. 

Bacteria. 

1.  What  are  bacteria? 

Minute  unicellular  plants,  many  of  them  invisible 
under  very  high  powers  of  the  microscope.  They 
are  called  fission  fungi,  also  schizomycetes.  They 
are  devoid  of  chlorophyll. 

2.  How  are  they  classified? 

According  to  their  forms.  The  spherical  or  oval 
forms  are  called  cocci;  rod-shaped  forms  are  called 
bacilli;  long  thread  forms,  leptothrix;  screw-like 
rods,  spirillse;  those  having  the  coils  drawn  out, 
vibrios;  those  with  long,  narrowly-twisted  screws, 
spirochsete. 

3.  How  are  the  cocci  classified? 

According  to  their  mode  of  grouping :  in  pairs  or 


20  COMPEND    OF 

double,  they  are  called  diplococci;  arranged  in 
chain  form,  streptococci;  in  clusters,  staphylococci. 
(These  are  the  spherobacteria  of  Cohn.) 

4.  What  is  the  composition  of  bacteria? 

They  are  made  up  of  a  plasma,  a  limiting  cell- 
wall,  both  composed  of  an  albuminous  substance 
called  mycoprotein.  Many  of  them  contain  a  nu- 
cleus. The  cell-wall  of  some  varieties  consists  of 
cellulose.  Some  of  the  bacteria  (not  the  cocci)  have 
flagellate  threads,  which  bring  about  mobility. 

5.  How  do  bacteria  multiply? 

By  transverse  division.  The  cells  elongate  and 
divide  in  two.  Others  divide  in  two  diameters;  the 
sarcina  dividing  into  fours.  Under  certain  condi- 
tions some  varieties  of  bacteria  appear  to  produce 
spores. 

6.  What  is  the  source  of  their  nutrition? 
Ready    formed    organic   substances,    soluble    in 

water.  They  require,  in  addition,  certain  mineral 
substances,  sulfur,  phosphorus,  potassium,  and 
other  elements. 

They  can  derive  their  carbon  from  carbohy- 
drates, which  are  soluble  in  water.  Their  nitrogen 
is  derived  from  albuminous  matter.  The  fungi 
give  ofif  a  ferment  which  peptonizes  the  albuminous 
matter  prior  to  assimilation.  They  all  require  an 
abundance  of  water. 

7.  Into  what  two  classes  are  bacteria  divided? 
Into   saprophytes   and   parasites.       Saprophytes 

live  upon  dead  organic  matter;  parasites  derive 
their  nutrition  from  living  organisms. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.        21 

8.  What  relation  has  the  supply  of  oxygen  to 
the  development  of  bacteria? 

To  some  free  oxygen  is  essential;  they  are  aero- 
bic. Others  derive  their  oxygen  from  formed 
organic  matter,  anaerobic;  free  oxygen  is  fatal  to 
them.  Still  others  develop  with  or  without  the 
presence  of  free  oxygen,  facultative  aerobics. 

9.  What  are  the  conditions  necessary  to  the  life 
of  fission  fungi? 

As  with  all  protoplasmic  masses,  a  proper  food- 
supply,  definite  temperatures,  and  an  inherent  vital- 
it}^  The  physiological  properties  can  change  under 
modifications  of  nutrition. 

10.  What  are  the  agencies  and  substances  called 
which  kill  the  fission  fungi? 

Germicides.  Mature  organisms  are  more  sus- 
ceptible to  their  action  than  are  their  spores.  Dif- 
ferent varieties  of  organisms  exhibit  wide  differ- 
ences in  their  resistance  to  different  germicidal 
agencies. 

11.  What  is  meant  by  fermentation? 
Destructive    changes    which    occur    in    nutritive 

media  as  a  consecjuence  of  the  growth  of  the  fission 
fungi.  It  is  not  known  whether  this  decomposition 
occurs  inside  the  cells  or  on  their  surfaces.  Fer- 
mentative processes  are  the  cause  of  nearly  all  de- 
compositions of  organic  matter,  the  putrefaction  of 
albumin.  They  change  milk  into  lactic  acid; 
sugar,  starch,  etc.,  into  lactic,  then  into  butyric  acid; 
alcohol  into  acetic  acid;  urea  into  ammonium  car- 
bonate. 


22  COMPEND    OF 

12.  How  is  the  decomposition  of  albumin  ef- 
fected? 

Peptones  are  first  formed;  next  ptomaines;  fol- 
lowing this,  nitrogenous  bases  are  formed,  the 
amins,  leucin,  etc.,  together  with  organic  fatty  acids; 
next  aromatic  products;  and,  finally,  the  end  prod- 
ucts are  hydrogen  sulfid,  ammonia,  carbon  dioxid, 
and  water.  Bodies  of  increasing  simplicity  of  chem- 
ical composition  are  formed. 

13.  What  great  oiBce  is  performed  by  bacteria 
in  the  economy  of  nature? 

They  break  down  the  complex  organic  matters, 
producing  substances  assimilable  by  plants. 

14.  What  are  pathogenic  organisms? 
Organisms  which,  developing  in  the  tissues  of 

the  living  body,  produce  disease. 

15.  What  are  the  effects  of  these  organisms? 

At  the  point  of  multiplication,  degenerations,  ne- 
crosis, inflammation,  and  new  growth  of  tissues, 
while  the  toxalbumins  produced  cause  manifesta- 
tions of  poisoning.  According  to  the  variety  of 
organisms,  any  one  or  more  of  these  results  may 
predominate. 

16.  What  is  the  fate  of  these  organisms? 

In  many  cases  they  die  out,  and  the  diseases 
caused  by  them  proceed  to  recovery.  Other  forms 
may  be  preserved  for  a  long  time  in  the  body,  and 
cause  continued  disease  process. 

17.  What  are  pyogenic  organisms? 

Those  whose  development  is  attended  by  the 
formation  of  pus;  those  which  cause  suppurative 
processes. 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       23 

18.  What  are  the  most  common  of  these? 
Staphylococcus    pyogenes    aureus    (the    coccus 

which  exists  in  ckisters  and  produces  orange- 
colored  pus) ;  the  Staphylococcus  pyogenes  albus — 
appears  white  in  cultures;  the  Streptococci  py- 
ogenes, or  the  chain  cocci,  and  the  diplococci,  or 
double  cocci. 

19.  Describe  the  process  of  suppuration. 

The  pyogenic  cocci  growing  in  a  tissue  produce 
irritating  waste  products;  and  the  results  of  irrita- 
tion follow,  viz :  increase  and  multiplication  of  fixed 
cells,  followed  by  the  phenomena  of  inflammation. 
The  organisms  excrete  a  ferment  which  peptonizes 
and  liquefies  the  exudation  and  intercellular  sub- 
stance; the  cells  die  and  form  pus-corpuscles;  these 
cells  are  themselves  liquefied.  The  inflammatory 
symptoms  are  usually  more  pronounced  than  in 
simple  inflammation. 

20.  What  is  the  difference  between  suppuration 
produced  by  the  staphylococcus  and  that  by  the 
streptococcus? 

The  former  usually  produces  circumscribed,  the 
latter  diffuse,  suppuration. 

21.  Name  some  of  the  usual  forms  of  bacteria 
found  in  the  human  mouth. 

The  bacilli  of  lactic  and  butyric  fermentation,  the 
pyogenic  cocci,  the  pneumococcus,  the  organisms 
of  actinomycosis,  and  many  others.  *rhe  conditions 
of  the  human  mouth  containing  carbohydrates,  dead 
albuminous  matters,  a  temperature  of  about  37°  C," 
and  abundance  of  moisture  are  such  as  to  favor  the 
development  of  many  organisms. 


24  COMPEND    OF 

22.  What  is  meant  by  lactic  fermentation? 
The  process  through  which   carbohydrates  are 

spHt  up  into  lactic  acid,  sugar  CgHiaOs  becoming 
lactic  acid  2(C3H603). 

23.  Why  is  this  process  of  extreme  interest  to 
the  dentist? 

Lactic  acid  is  the  substance  which  effects  the  so- 
lution of  the  calcium  salts  of  the  teeth,  inaugurating 
the  process  of  caries. 

24.  What  factors  are  essential  to  the  process? 

The  presence  of  the  bacillus  of  lactic  fermenta- 
tion: soluble  carbohydrates,  such  as  sugar;  nitro- 
genous material,  and  a  proper  temperature,  all  of 
which  conditions  are  almost  constant  in  the  human 
mouth. 

25.  What  are  the  general  effects  of  the  develop- 
ment of  pathogenic  organisms  in  the  body? 

The  products  of  their  action  upon  albuminous 
substances  gain  entrance  to  the  circulation,  and 
fever,  septic  intoxication,  or  septic  poisoning  oc- 
cur. Should  the  organisms  themselves  gain  en- 
trance to  the  veins,  they  may  be  carried  to  distant 
parts,  and  form  disease  foci.     This  is  pyemia. 

Fever. 

1.  What  is  fever? 

A  general  condition,  characterized  by  an  eleva- 
tion of  the  bodily  temperature  as  its  most  promi- 
nent symptom,  and  which  fluctuates  or  persists  for 
a  variable  period. 

2.  What  are  its  causes? 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       25 

As  a  rule  the  absorption  from  a  focus  of  disease 
and  presence  in  the  circulating  fluids  of  the  pro- 
ducts of  specific  fermentations. 

3.  What  are  the  symptoms  of  fever? 

Increase  of  the  bodily  temperature,  increased  fre- 
quency of  the  pulse,  usually  a  feeling  of  illness,  con- 
stipation, a  decrease  in  the  amount  of  urine  ex- 
creted, and  an  increase  of  the  urea  contained  in  it. 

4.  What  causes  the  elevation  of  temperature 
and  increase  of  urea? 

There  is  an  increase  in  the  amount  of  CO,  ex- 
creted and  exhaled;  an  increase  in  the  amount  of  O 
inhaled,  so  that  increased  oxidation  occurs,  elevat- 
ing the  temperature;  the  urea  is  the  product  of  the 
oxidation. 

5.  Into  what  classes  are  fevers  divided? 

Into  periodic  and  continued.  Periodic  fevers 
are  those  which  have  periods  during  which  the  ele- 
vation of  temperature  is  almost  or  quite  absent. 
Continued  fevers,  those  in  which  the  temperature 
is  subject  only  to  the  daily  variations,  associated 
with  the  normal  temperature.  The  normal  tem- 
perature, morning,  is  98°  F. ;  evening,  99°  F. ;  the 
average  temperature  being  98.8°  F.  to  99.3°  F. 

6.  How  are  fevers  graded  in  severity? 

First  by  the  amount  of  temperature  elevation; 
100.5°  to  101.3°,  sHghtly  febrile;  101.3°  to  103.1°, 
moderate  fever;  103.1°  to  104.9°,  marked  fever. 
Any  temperature  above  105.8°,  hyperpyrexia. 

7.  What  is  the  prognostic  significance  attaching 
to  temperature? 

5 


26  COMPEND    OF 

The  higher  and  longer  continued  the  tempera- 
ture the  greater  oxidation,  hence  the  greater  loss 
of  the  nitrogenous  constituents  of  the  body.  Con- 
tinued high  temperatures  are  attended  by  granular 
degenerations  of  the  glands  and  muscles.  Tem- 
peratures as  high  as  io8°  F.  to  113°  F.  have  been 
noted  in  sunstroke  cases.  As  a  rule,  temperature 
above  106°  F.,  continued,  denotes  a  fatal  ending  to 
a  malady. 

8.  To  what  is  death  from  fever  usually  due? 
To    cardiac   failure.     Fevers   are   dangerous    in 

the  degree  that  they  are  attended  by  weakened 
heart-action,  evidenced  by  weak  heart-sounds,  a 
frequent  and  soft  pulse. 

9.  What  is  the  general  therapeutics  of  fever? 

F"irst,  reduction  of  temperature.  The  most  effi- 
cient means  of  attaining  this  end  is  removing  the 
source  of  infection  where  and  when  possible;  if 
from  a  local  inflammatory  focus,  removing  the 
cause  of  and  subduing  the  inflammation.  If  the 
source  be  irremovable,  the  employment  of  cool 
baths  and  antipyretic  drugs  to  reduce  the  temper- 
ature, and  sustaining  the  action  of  the  heart  by  the 
administration  of  stimulants. 

10.  With  what  form  of  fever  may  the  dentist 
meet? 

Surgical  fever,  due  to  the  absorption  of  pyro- 
genous  (fever-producing)  material  from  a  focus  of 
disease  about  the  jaws. 

11.  What  is  its  treatment? 

The  removal  of  the  local  sources  of  fermentation, 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       2/ 

and  the  treatment  by  sedation   or  stimulation  of 
constitutional  symptoms. 
(See  Septicemia.) 

Septicemia  and  Pyemia, 

1.  What  is  meant  by  septicemia? 

The  entrance  into  the  blood,  the  circulation  of 
and  effects  of  the  products  of  bacterial  decompo- 
sitions upon  the  body. 

2.  How  is  it  classified? 

Into  septic  intoxication,  septic  poisoning,  and 
pyemia.  These  express  grades  of  severity  of  the 
septic  process.  The  intoxication  is  probably 
caused  by  one  or  more  sets  of  waste  products,  or  by 
the  same  products  which  cause  septic  poisoning, 
when  they  are  present  in  lesser  amounts.  The 
septic  poisoning  is  due  to  the  entrance  of  bacterial 
alkaloids  or  toxalbumins  into  the  blood;  the  pyemia, 
due  to  the  entrance  of  the  organisms  themselves  to 
the  circulation  and  their  multiplication  in  distant 
parts.  All  three  of  these  processes  may  exist  at  the 
same  time. 

3.  What  are  the  symptoms  of  septicemia? 

In  general,  a  chill,  followed  by  a  rise  of  tempera- 
ture, headache,  nausea,  vomiting,  and  perhaps  di- 
arrhea, followed  by  delirium  and  coma.  The  symp- 
toms depend  upon  the  nature  of  the  poison, — i.  e., 
the  character  of  the  infecting  organisms. 

4.  What  is  the  treatment? 

The  removal  of  the  source  of  disturbance,  the  use 
of  antiseptics  to  destroy  any  organisms  present  in 


28  COMPEND    OF 

accessible  parts,  the  washing  out  of  their  products. 
The  strength  of  the  patient  is  maintained  through 
the  use  of  quinine  and  stimulants  until  the  excre- 
tory organs  shall  have  eliminated  the  poison  from 
the  circulating  fluids. 

Embolus  and  Thrombus. 

1.  What  is  an  embolus? 

A  plug  closing  the  lumen  of  an  artery. 

2.  What  are  its  efifects? 

If  in  an  artery  which  has  no  anastomosis,  there 
is  death  and  degeneration  of  the  tissues  supplied 
by  the  artery.  The  general  effects  depend  upon 
whether  the  embolus  is  septic  or  non-septic.  If 
septic,  it  becomes  the  focus  of  disease  processes. 

3.  What  is  a  thrombus? 

A  plug  forming  in  a  blood-vessel  which  causes 
the  obstruction  and  occlusion  of  the  vessel. 

4.  What  are  its  effects? 

Those  of  an  embolus,  but  the  symptoms  are  of 
gradual  growth.  As  thrombi  usually  form  in  veins, 
there  is  an  increasing  severity  of  the  symptoms  of 
mechanical  hyperemia. 

5.  What  is  an  infarction? 

The  area  of  tissues  supplied  by  a  terminal  artery 
is  deprived  of  nutrition  when  an  embolus  occludes 
the  artery;  the  area  undergoes  degeneration;  the 
area  of  degeneration  is  known  as  an  infarct. 

Necrosis. 
I.     What  is  meant  by  necrosis? 
Death  of  the  cellular  elements  of  a  part. 


DENTAL    PATHOLOGY   AND   THERAPEUTICS.       29 

2,  What  are  its  causes? 

Anything  which  interferes  with  the  supply  of 
nutritive  material  to  a  part,  or  which  directly  des- 
troys the  vitality  of  the  cellular  elements.  Ob- 
structions of  arteries,  of  capillaries,  or  of  veins  are 
causes.  Diminished  cardiac  power  is  an  element 
in  causation.  Inflammation  is  a  common  cause. 
Physical  forces,  such  as  excessive  heat  or  cold, 
acids  and  caustic  alkalies,  and  the  waste  products 
of  bacterial  life,  are  causes  which  destroy  the  vital- 
ity of  cellular  elements. 

3.  What  is  a  predisposing  cause? 
Debility  of  tissues. 

Regeneration.  ' 

1.  What  is  meant  by  the  regeneration  of  tissues? 
The  process  through  which  lost  tissues  are  re- 
placed by  the  vital  parts. 

2.  How  is  this  accomplished? 

For  example  may  be  cited  the  filling  of  an  ab- 
scess-cavity after  the  evacuation  of  the  pus.  The 
cells  forming  the  walls  of  the  cavity  undergo  pro- 
liferation; first  the  nuclei  undergo  changes  of 
form,  and  finally  divide  into  two ;  the  cell  body  itself 
next  divides,  and  the  cavity  becomes  filled  with 
small  round  cells.  Blood-vessels  grow  in  loops 
from  adjoining  vessels,  and  penetrate  the  mass  of 
new  cells,  which  go  on  to  organization,  replacing 
the  lost  parts. 

3.  What  is  necessary  that  this  may  occur? 
Sources  of  irritation  must  be  removed,  or  else  the 

new  tissue  degenerates  instead  of  organizing. 


30  COMPEND    OF 

4.  What  is  the  new  tissue  called? 
Scar  tissue. 

5.  What  relation  does  the  scar  tissue  bear  to  the 
normal  tissue? 

Tissues  of  the  highest  order  are  reproduced  by 
fibrous  connective  tissue,  not  by  those  of  their  orig- 
inal form. 

Dental  Histology. 

1.  Of  what  tissues  is  a  human  tooth  composed? 
Of  a  general  body  called  dentine,  which  is  covered 

upon  its  crown  by  enamel,  upon  its  root  portion  by 
cementum.  A  nervo-vascular  tissue  occupies  and 
fills  an  interior  chamber  in  the  dentine;  a  fibrous, 
nervo-vascular  tissue  called  the  pericementum 
sheathes  the  cementum. 

2.  What  is  enamel? 

It  is  the  hardest  substance  of  the  animal  body, 
containing  from  2  per  cent,  to  5  per  cent,  of  organic 
matter;  from  95  per  cent,  to  98  per  cent,  of  inor- 
ganic matter. 

3.  What  is  its  chemical  composition? 

Calcium  phosphate  and  fluorid 89.82 

"         carbonate 4.37 

Magnesium  phosphate 1.34 

Other  salts 88 

Cartilage 3.39 

?Fat    20 

(Von  Bibra.) 
The  inorganic  constituents  are  combined  with  an 
albuminous  substance,  forming  calcoglobulin. 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       3 1 

4.  What  is  its  anatomical  composition? 
Enamel  is  made  up  of  wavy  hexagonal  prisms, 

arranged  with  their  axes  pointing  toward  the  center 
of  the  pulp-cavity.  Seen  in  sections,  magnified,  the 
prisms  are  crossed  obliquely  by  a  series  of  parallel 
brown  stripes,  the  stripes  of  Retzius. 

A  series  of  irregular  pigmented  markings  cross- 
ing the  former  almost  at  right  angles  are  called  the 
stripes  of  Schreger. 

5.  What  is  the  sub-enamel  membrane? 

A  structure,  the  existence  of  which  is  questioned, 
which  marks  the  boundary  between  the  enamel  and 
the  underlying  dentine. 

6.  What  is  the  dentine? 

Dentine  is  the  substance  of  which  the  body  of  a 
tooth  is  composed. 

7.  What  is  its  composition,  chemical? 

It  differs  with  the  age  of  the  patient  and  in  the 
several  teeth  of  the  individual.  Under  fifteen  years 
— S.  G.,  2.066;  per  cent,  of  water,  11.89;  organic 
matter,  25.92;  inorganic  matter,  62.26. 

Average — over  60  years — S.  G.,  2.106;  water, 
10.66;  organic  matter,  24.81;  inorganic  matter, 
64.56.     (Black.) 

When  dry,  its  average  chemical  composition  is — 

Organic  matter 27.61 

Fat 0.40 

Palcium  phosphate  and  fluorid 66.72 

"         carbonate 3.36 

Magnesium  phosphate 1.18 

Other  salts 83 


32  COMPEND    OF 

8.  What  is  the  anatomical  structure  of  dentine? 
It  consists  of  a  calcified  basis-substance,  traversed 

by  tubuli  radiating  from  the  pulp-chamber  in 
curved  lines  to  the  under  surface  of  the  enamel. 
The  tubuli,  averaging  i-ioooo"  in  diameter,  are 
branched,  so  that  the  dentine  represents  a  net- work 
of  tubules.  Each  tubule  has  around  it  a  covering 
more  resistant  to  the  action  of  acids  than  the  basis- 
substance  of  the  dentine;  these  coverings  or  walls 
are  called  the  sheaths  of  Neumann.  Properly  pre- 
pared sections  exhibit  a  fibrous  basement-structure 
to  the  dentine  (gelatin-yielding  fibers). 

9.  What  are  interglobular  spaces? 

These  are  defined  areas  of  non-calcification  found 
in  the  substance  of  the  dentine.  The  dentinal  tubuli 
may  be  continuous  on  either  side  of  them. 

10.  What  occupy  the  dentinal  tubuli? 

They  are  occupied  by  protoplasmic  prolongations 
from  the  boundary  cells,  the  odontoblasts  (the  mem- 
brana  eboris)  of  the  pulp.  They  transmit  sensation 
to  the  pulp,  and  are  the  seat  of  nutritive  changes 
and  disturbances. 

11.  What  is  the  dental  pulp? 

It  is  the  contracted  papilla  over  which  the  dentine 
was  formed.  It  represents  in  form  an  attenuated 
copy  of  the  tooth  form. 

12.  Describe  it. 

It  consists  of  a  loose  fibro-cellular  net-work,  in- 
closing arteries,  veins,  and  nerves,  but  no  demon- 
strable lymphatics.  The  large  vessels  and  nerves 
enter  at  the  foramen  at  the  end  of  the  root;  the  ves- 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       ^^ 

sels  break  up  into  a  plexus  of  capillary  loops;  the 
nerve-trunks  break  up  into  a  net-work  plexus  be- 
neath the  peripheral  cells  of  the  pulp,  the  odonto- 
blasts; the  exact  mode  of  nerve  termination  is  un- 
known. 

13.  What  are  the  odontoblasts? 

They  form  a  layer  upon  the  periphery  of  the  pulp, 
formerly  known  as  the  membrana  eboris.  The  cells 
are  cylindrical  in  form;  they  are  placed  together 
like  cylindrical  epithelium.  One,  and  occasionally 
more  than  one,  prolongations  extend  from  their 
distal  extremities  and  occupy  the  dentinal  tubuli. 
At  their  proximate  ends  are  large  nuclei.  These 
are  the  dentine-forming  cells.  Under  abnormal 
conditions,  other  cells  of  the  pulp  may  take  on  a 
similar  formative  function.  In  the  body  of  the  pulp 
its  cells  are  irregularly  arranged  in  a  gelatinous 
matrix;  in  the  root  they  are  arranged  with  their 
long  axes  parallel  with  that  of  the  pulp. 

14.  What  is  cementum? 

It  is  a  modified  bone,  covering  the  roots  of  the 
teeth,  pierced  at  the  apex  by  a  canal  which  trans- 
mits the  nervous  and  vascular  supply  of  the  pulp. 
It  overlaps  the  enamel  slightly  at  its  gingival  end.. 
The  cementum  contains  numerous  bone-corpuscles 
and  lacunae;  occasionally  evidences  of  a  Haversian 
system  are  seen.  The  layer  o£  cementum  is  thickest 
at  the  apex  of  the  root,  gradually  thinning  toward 
the  enamel.  There  is  no  distinct  line  of  demarka- 
tion  between  the  dentine  and  cementum.  Imme- 
diately beneath  the  cementum,  in  the  dentine,  an 


34  COMPEND    OF 

irregular  layer  (Tomes  granular  layer)  is  seen,  its 
elements  lying  between  the  terminals  of  the  den- 
tinal tubuli;  these  latter  occasionally  enter  the  ce- 
mentum. 

15.  What  is  the  pericementum? 

It  is  a  fibro-vascular  membrane,  encasing  the 
cementum  of  the  teeth,  and  forms  the  ligament 
which  binds  the  teeth  to  their  articulating  surfaces, 
the  walls  of  the  alveoli.  It  is  plentifully  supplied 
with  nerve-fibers. 

16.  Describe  the  pericementum  in  detail. 

Its  fibers  radiate  from  the  root,  and  are  attached 
at  higher  levels  in  the  alveolus,  so  that  the  tooth  is 
swung  in  its  socket;  the  elasticity  of  the  fibers  per- 
mits mobility  of  the  tooth,  and  draws  it  into  posi- 
tion, when  stress  is  removed.  At  the  apex  of  the 
root  the  fibers  radiate,  fan-like,  from  the  root  to  the 
alveolus.  At  their  other  extremity  they  merge  into 
the  periosteum  covering  the  alveolar  wall,  forming 
a  thickened  layer  which  has  been  named  the  dental 
ligament.  The  artery  which  enters  the  apical 
space,  which  lies  between  the  apex  of  the  root  and 
the  alveolus,  breaks  up  into  a  number  of  branches ; 
one  or  more  of  these  enter  the  foramen  to  supply  the 
pulp ;  the  others  peTietrate  the  substance  of  the  peri- 
cementum and  anastomose  with  the  arteries  from 
the  alveolar  walls.  The  nerves  follow  the  same 
course. 

17.  What  is  the  apical  space;  what  tissues  oc- 
cupy it? 

It    contains    the    thickest    portion    of    the    peri- 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       35 

cementum,  the  arterial  and  nervous  trunks  supply- 
ing pulp  and  pericementum  and  the  emergent  veins 
of  pulp  and  pericementum. 

lis.  Describe  the  apical  portion  of  the  pulp- 
canal. 

It  is  composed  of  cementum,  and  after  the  de- 
struction of  the  ptdp  may  contain  living  cells  (ce- 
mentoblasts),  while  the  dentine  is  dead. 

19.  Describe  the  alveolar  process. 

It  is  a  provisional  bony  structure  for  maintaining 
the  teeth  in  position.  It  is  a  process  growth  from 
the  bodies  of  the  inferior  and  superior  maxillary 
bones;  diverging  from  the  body  of  the  bone  in  the 
superior  maxilla;  converging  in  the  inferior.  It 
rises  about  the  teeth  so  that  each  tooth  is  inclosed  in 
a  socket,  called  an  alveolus.  Its  outer  walls  and 
alveolar  lining  are  of  cortical  bone;  its  substance  of 
spongy  bone,  the  chambers  of  which  are  arranged 
so  that  they  form  a  chambered,  spongy,  and  elastic 
bed.  The  blood-vessels  from  their  outer  wall  anas- 
tomose with  those  of  the  pericementum.  Nerves 
from  the  same  source  follow  the  same  course.  Its 
immediate  external  coating  is  a  periosteum,  a  con- 
tinuation of  that  of  the  body  of  the  bone. 

20.  What  are  the  gums? 

Firm  and  elastic  coverings  to  the  periosteum  of 
the  alveolar  process. 

21.  What  is  their  structure? 

They  are  covered  above  with  squamous  epi- 
thelium of  unusual  depth;  this  layer  rests  upon  en- 
larged papillae  covered  with  cuboidal  epithelium; 


36  COMPEND    OF 

the  subepithelial  layer  is  composed  of  densely  inter- 
lacing fibers  continuous  with  the  periosteum  of  the 
alveolar  process. 

Dental  Anatomy, 

1.  What  are  teeth? 

Hard  bodies  situated  in  the  anterior  portion  of  the 
alimentary  canal,  designed  for  the  purpose  of  seiz- 
ing, cutting,  or  crushing  food.  In  the  higher  mam- 
mals they  are  confined  to  the  cavity  of  the  mouth. 

2.  How  are  teeth  arranged? 
Symmetrically  upon  either  side  of  the  median 

line. 

3.  What  is  the  median  line? 

An  imaginary  line  dividing  the  body  into  right 
or  left  symmetrical  halves. 

4.  What  is  a  dental  formula? 

It  represents  the  number  of  teeth  and  their  ar- 
rangement into  classes.  It  is  distinctive  for  each 
zoological  family. 

5.  What  is  the  dental  formula  of  the  deciduous 
human  teeth? 

Molars.  Premolars.         Cuspids.  Incisors. 


20  12 

6.     What  is  the  formula  of  the  permanent  teeth? 
Premolars.  Canines. 

Molars.  Bicuspids.  Cuspids.         Incisors. 

3212 

3212 


DENTAL    TATHOLOGY    AND    THERAPEUTICS.       37 

7.  What  form  has  the  temporo-maxillary  articu- 
lation in  man? 

It  is  a  combination  of  the  rounded  head  and  deep 
glenoid  fossa  found  in  the  carnivora,  with  the  flat- 
tened head  and  socket  found  in  herbivorous  ani- 
mals. 

8.  What  does  this  indicate? 

That  man  is  both  a  carnivorous  and  herbivorous 
animal, — is  omnivorous. 

9.  What  is  the  arrangement  of  the  muscles  of 
mastication? 

They  accomplish  a  combination  of  direct  up  and 
down  movements  of  the  mandible  with  a  well- 
marked  lateral  movement.  The  extent  of  either 
movement  depends  upon  the  manner  in  which  the 
teeth  occlude ;  it  varies  as  the  individual. 

10.  What  general  forms  have  the  teeth? 

A  combination  of  forms  designed  for  both  cutting 
and  crushing.  The  occlusion  of  the  teeth,  the  joint 
articulation  and  muscular  distribution,  are  in 
mutual  correspondence. 

11.  How  arc  the  surfaces  of  the  teeth  named? 
Those  which  underlie  the  lip  are  called  the  labial 

surfaces.  The  outer  surfaces  of  the  12  anterior 
teeth  (6  upper,  6  lower)  have  labial  surfaces.  Sur- 
faces underlying  the  cheek  are  called  buccal,  the 
outer  surfaces  of  the  20  posterior  teeth.  The  inner 
surfaces  of  the  upper  teeth  are  called  the  lingual. 
The  inner  surfaces  of  the  lower  teeth  are  called  the 
lingual.  The  surface  of  a  tooth  which  presents  to 
the  median  line  is  called  its  mesial  surface;  that 


38  COMPEND    OF 

pointing  from  the  median  line  the  distal.  The  artic- 
ulating faces  of  incisors  and  cuspids  are  called  their 
cutting-edges ;  those  of  the  bicuspids  and  molars  the 
masticating  surfaces.  The  sharp  points  of  teeth  are 
called  the  cusps.  The  lines  at  the  bases  of  the  cusps 
are  called  sulci.  The  surfaces  of  adjoining  teeth 
which  are  in  contact  are  called  approximal. 

12.  From  what  simple  form  are  all  tooth  forms 
derived? 

From  a  simple  cone. 

13.  How  is  the  cone  modified? 

By  compression,  and  union  with  other  cones. 

14.  What  is  the  general  form  of  incisors? 

The  cone  is  truncated,  and  its  top  compressed 
into  a  wide,  almost  straight  edge. 

15.  AVhat  is  the  form  of  the  cuspids? 

The  cone  is  compressed  upon  either  side  of  the 
apex,  which  projects  as  a  point  or  cusp. 

16.  How  are  bicuspids  formed? 
By  the  union  of  two  simple  cones. 

17.  What  is  the  relation  of  the  roots  of  the  teeth? 
Each  primitive  cone  bears  a  conical  root  as  a  gen- 
eral rule,  although  the  appearance  is  often  obscure. 

18.  Flow  are  molars  formed? 

Upper  molars  by  the  union  of  three  cones;  lower 
molars  by  the  union  of  four. 

19.  Describe  the  upper  central  incisors. 
They  possess  a  tapering  root  having  the  general 

form  of  a  much  rounded  triangle,  its  base  at  the  la- 
bial aspect.  The  crowns  are  of  spade  form,  con- 
vex, labially  concave  lingually,  the  concavity  being 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       39 

formed  by  the  presence  of  two  lateral  buttresses  ris- 
ing from  the  middle  of  the  cervical  portion  and 
curving  outwardly  to  terminate  at  the  angles  of  the 
cutting-edge.  Its  mesial  and  distal  faces  are  both 
triangular,  the  latter  more  rounded  than  the  former. 
The  mesial  angle  of  the  cutting-edge  is  almost  or 
quite  acute;  the  distal  angle  is  rounded. 

20.  Describe  the  upper  lateral  incisors. 

They  are  much  smaller  than  the  central  incisors, 
more  rounded  labially  and  more  concave  lingually, 
the  lateral  iDuttresses  being  more  marked.  Both 
mesial  and  distal  surfaces  are  more  rou;ided  than  ia 
the  central  incisor.  The  mesial  angle  at  the  cutting- 
edge  is  more  acute,  the  distal  more  rounded.  The 
root  is  smaller  and  rounder  than  that  of  the  central, 
and  exhibits  a  tendency  to  curving,  at  times  ab- 
ruptly.    This  tooth  is  occasionally  absent. 

21.  Describe  the  upper  cuspid. 

From  its  resemblance  to  the  typical  tooth  of  the 
carnivora  it  is  called  a  canine.  Its  root  is  larger 
than  that  of  the  central  incisor,  longer  and  more 
prominent,  and  has  a  tapering  form,  elliptical  on 
section.  The  crown  is  much  rounded  labially,  ter- 
minating in  a  sharp  point,  which  is  mesial  to  the 
middle  line  of  the  crown.  The  cutting-edges  slope 
away  from  the  point,  the  longer  edge  being  distal. 
The  lingual  surface  is  marked  by  three  buttresses, 
one  in  the  median  line,  one  at  either  border,  the 
three  blending  in  a  rounded  prominence  at  the  mid- 
dle of  the  conical  portion  of  the  crown. 

22.  What  common  structural  defects  are  found 
in  the  teeth  thus  far  described? 


40  COMPEND    OF 

At  the  points  of  union  of  the  buttresses  with  the 
depressed  surfaces  of  the  crowns,  pits  may  be  found 
which  become  the  seats  of  caries, 

23.  Describe  the  upper  bicuspids. 

They  are  elhptical  upon  transverse  section.  Their 
buccal  surfaces  are  convex  in  both  directions,  which 
is  also  true  of  their  lingual  surfaces.  As  their  name 
implies,  they  have  two  cusps,  the  outer  the  sharper 
and  more  triangular;  the  cusps  join  at  their  bases, 
forming  a  sharp  sulcus  which  is  frequently  a  fis- 
sure. At  each  end  of  the  sulcus  there  is  a  depres- 
sion. The  outer  cusps  exhibit  a  modification  of  the 
three  buttresses  of  the  cuspid.  The  inner  cusp  is 
more  smooth  and  rounded.  The  teeth  taper  from 
the  line  marking  the  bases  of  the  cusps,  their  point 
of  contact,  to  the  ends  of  the  roots,  which  are  also 
elliptical  on  section.  The  root  of  the  first  bicuspid 
is  frequently  double  or  bifurcated  toward  its  apex. 
The  first  bicuspid  is  slightly  larger  than  the  second. 

24.  Describe  the  upper  first  molar. 

It  has  upon  section  a  rhomboidal  form,  the  inner 
cone  of  formation  being  flattened.  The  prominent 
angle  of  the  rhomboid  is  the  mesio-buccal.  The 
opposite  angle,  the  disto-lingual,  is  not  so  acute; 
the  other  angles,  disto-buccal  and  mesio-lingual,  are 
both  rounded.  The  three  primitive  cones  are 
marked  by  the  two  buccal  and  the  mesio-lingual 
cusps.  The  fourth  cusp  of  the  tooth  is  added  to  the 
lingual  cone  distally,  and  marked  ofiF  from  it  by  a 
more  or  less  well-defined  fissure.  The  cusps  are 
bound  together  by  enamel  girders,  one  at  the  mesial 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       4I 

edge,  one  extending  from  the  mesio-lingual  cusp  to 
the  disto-buccal  cnsp.  The  sulci  between  the  cusps 
frequently  exhibit  fissures  and  pits.  The  buccal 
cusps,  as  in  all  the  upper  teeth,  are  sharp;  the  lin- 
gual cusps  and  crown  surfaces  rounded.  The  roots 
are  three  in  number,  one  for  each  of  the  primitive 
cones,  two  buccal,  the  distal  the  smaller;  the  palatal 
or  lingual  root  is  large  and  round.  As  a  rule  the 
roots  are  divergent,  but  may  be  bent  into  any  form. 

25.  Describe  the  upper  second  molar. 

It  is  smaller  than  the  first  molar,  is  almost  a  much 
rounded  triangle  on  section.  The  mesio-buccal 
angle  is  more  pronounced;  the  lingual  surface  is 
rounded  in  all  directions;  the  form  of  the  lingual 
cone  is  more  pronounced,  the  fissure  marking  the 
junction  of  the  fourth  cusp  is  less  pronounced  and 
more  distal.  The  roots,  as  a  rule,  diverge  less  than 
those  of  the  first  molar,  the  tooth  being  altogether 
smaller. 

26.  Describe  the  upper  third  molar. 

The  three  primitive  cones  are  evident.  The  tooth 
on  section  is  an  oval,  slightly  flattened  upon  its 
mesial  and  buccal  faces.  The  largest  cone  and  cusp 
are  the  lingual,  the  smallest  the  disto-buccal.  The 
three  roots  of  this  tooth  are  commonly  compressed 
into  one  root  curving  backward,  in  which  the  three 
roots  are  more  or  less  clearly  defined.  There  may 
be  a  pulp-canal  for  each  root,  or  there  may  be  but 
one  central  canal. 

27.  Describe  the  lower  incisors. 

7 


42  COMPEND    OF 

They  are  truncated  cones,  flattened  upon  the 
sides,  and  having-  their  tops  compressed  into  thin 
cutting-edges  narrower  than  those  of  the  upper 
incisors.  They  are  triangular,  viewed  either  at 
their  labial  or  lingual  or  at  their  distal  or  mesial 
faces.  The  labial  faces  are  almost  flat,  and  marked 
faintly  by  three  longitudinal  ridges.  At  their  necks 
thev  are  oval  upon  section,  the  lingual  surface  of  the 
crown  concaved  longitudinally  to  form  a  chisel 
shape.  The  lateral  incisor  is  larger  than  the  central. 
The  distal  angles  of  the  laterals  mark  the  median 
lines  of  the  upper  lateral  incisors. 

28.  What  is  the  general  relation  of  the  lower 
to  the  upper  teeth? 

The  upper  arch  is  larger,  and  therefore  the 
outer  cusps  and  cutting-edges  of  the  teeth  close  out- 
side of  those  of  the  lower  teeth.  The  buccal  edges 
of  the  upper  teeth  are  the  sharper  in  that  denture, 
the  lingual  cusps  being  the  sharper  in  the  lower  den- 
ture. The  lines  of  division  between  the  lower  teeth 
mark  nearly  the  middle  lines  of  the  upper  teeth;  the 
teeth  of  the  lower  jaw  being  one-half  a  tooth  in  ad- 
vance of  those  of  the  upper  jaw. 

29.  Describe  the  lower  cuspids. 

Their  general  form  is  that  of  the  upper  cuspids, 
the  ridge  descending  from  the  cusp  to  the  cervix 
upon  the  labial  w^all  is  curved  toward  the  mesial 
edge.  The  distal  cutting-edge  is  longer,  the  mesial 
shorter,  than  in  the  upper  cuspid.  The  lingual  sur- 
face is  but  faintly  ridged  as  compared  with  the  up- 
per cuspid,  resembling  more  nearly  the  lower  in- 


DENTAL   PATHOLOGY   AND   THERAPEUTICS.       43 

cisors.     Its  root  is  elliptical,  and  smaller  than  that 
of  the  upper  cuspid. 

30.  Describe  the  lower  first  bicuspid. 

It  is  not  a  true  bicuspid,  but  more  nearly  a  cuspid, 
having  an  exaggerated  lingual  tuberosity,  the  lin- 
gual cusp  being  primitive.  As  in  all  of  the  lower 
posterior  teeth,  its  lingual  wall  is  comparatively 
straight,  its  buccal  convex  in  both  directions.  Ris- 
ing from  the  primitive  lingual  cusp,  a  ridge  of 
enamel  ascends  to  the  buccal  cusp;  two  lateral 
ridges  or  girders  ascend  from  the  bases  of  the  lin- 
gual cusp;  between  these  ridges  there  is  a  mesial 
and  a  distal  pit.  Its  root  is  elliptical,  nearly  oval; 
smaller  than  that  of  the  lower  cuspid  and  the  second 
bicuspid. 

31.  Describe  the  lower  second  bicuspid. 

It  is  larger  than  the  first  bicuspid.  A  semi- 
circular sulcus  outlines  the  base  of  the  buccal  cusp. 
The  lingual  cusp  more  nearly  resembles  an  edge 
than  a  pointed  cusp,  and  is  frequently  marked  by  a 
fissure  which  may  divide  the  lingual  cusp  into  two 
distinct  sections. 

32.  Describe  the  lower  first  molar. 

It  is  formed  of  four  primitive  cones,  two  buccal 
and  two  lingual.  It  has  five  cusps,  the  bucco-distal 
cone  bearing  the  extra  cusp,  which  is  the  smallest 
of  the  five,  at  its  distal  angle.  The  shape  of  the 
crown  is  trapezoidal,  the  long  parallel  side  at  the 
buccal  aspect.  The  crown  has  four  main  sulci, 
two  buccal,  which  pass  from  the  median  longitudi- 
nal sulcus,  between  the  buccal  cusps,  down  upon  the 


44  COMPEND    OF 

convex  buccal  wall.  A  single  lingual  sulcus  passes 
from  the  longitudinal  fissure  to  between  the  lingual 
cusps,  usually  terminating  at  the  lingual  edge.  The 
roots  are  two,  rounded  at  their  buccal  and  lingual 
edges,  much  flattened  at  their  mesial  and  distal, 
showing  clearly  the  four  primitive  roots.  The  an- 
terior root  frequently  shows  a  distinct  canal  for 
buccal  and  labial  sections  of  the  root.  The  distal 
root  is  rarely  thus  distinguished,  there  being,  as  a 
rule,  but  one  large  elliptical  canal.  The  lower  first 
molar  is  the  largest  tooth  of  the  dental  series. 

33.  Describe  the  lower  second  molar. 

It  is  formed  of  four  primitive  cones,  each  of  which 
is  surmounted  by  a  cusp.  The  sulci  are  cruci- 
form, outlining  the  four  cusps.  The  crown  is  almost 
rectangular,  and  smaller  than  that  of  the  first  molar. 
The  roots  are  similar  to  those  of  the  first  molar, 
but  curve  backward. 

34.  Describe  the  lower  third  molar. 

It  is  formed  of  four  primitive  cones,  surmounted 
by  four  distinct  and  usually  an  extra  faintly-marked 
cusp  upon  the  disto-buccal  cone.  The  outline  of 
the  crown  is  nearly  oval;  the  flattened  broad  end  of 
the  oval  mesial,  the  small  end  distal.  The  sulci 
resemble  those  of  the  first  molar,  but  usually  have 
numerous  irregularities.  The  two  roots  are  usually 
more  or  less  fused  together,  and  curve  backward. 

Dental  Embryology. 

I.     What  is  the  first  stage  of  tooth  formation? 
An   involution    of   the    epithelium    covering   the 
summits  of  the  embryonic  jaws. 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       45 

2.  How  soon  is  it  formed? 

In  the  sixth  week  of  intra-uterine  life. 

3.  From  what  embryonic  layers  do  the  dental 
tissues  arise? 

From  the  epiblastic  and  the  mesoblastic. 

4.  What  tissues  are  formed  by  each? 

The  enamel  by  the  epiblastic;  the  dentine,  ce- 
mentum,  pericementum,  alveolar  walls,  and  pulp 
from  the  mesoblastic. 

5.  What  is  the  tooth  sac? 

It  is  a  fibro-vascular  structure  inclosing  the  en- 
tire developing  tooth,  and  which  subsequently  be- 
comes, in  part,  the  pericem.entum. 

6.  What  cells  form  the  enamel? 

Elongated  cells  from  the  deepest  epithelial  layer, 
which  are  called  the  ameloblasts. 

7.  What  is  the  composition  of  the  enamel- 
organ  ? 

It  consists  of  a  double  layer  of  epithelial  cells,  the 
layer  separated  by  a  quantity  of  myxomatous  tis- 
sue, owing  to  the  peculiar  appearance  of  which, 
when  seen  in  sections,  it  is  called  the  stellate  retic- 
ulum. 

8.  What  is  the  vascular  supply  of  the  enamel- 
organ  ? 

Its  external  epithelial  coat  is  covered  by  a  layer 
of  fibrous  tissue,  in  which  ramify  numerous  blood- 
vessels. The  pabulum  of  the  ameloblasts,  therefore, 
passes  from  the  vessels  through  the  external  epi- 
thelial covering,  into  the  stellate  reticulum,  from 
which  it  is  taken  by  the  ameloblasts,  passing  to 


46  COMPEND    OF 

them  through  a  membranous  structure  covering 
them.  Later  the  outer  epithehal  coating  and  stel- 
late reticulum  disappear,  an4  the  ameloblastic 
layer  is  separated  from  the  vascular  supply  by  Avhat 
appears  to  be  a  glandular  tissue. 

9.  How  is  the  enamel  formed? 

At  the  distal  ends  of  the  ameloblasts  numerous 
glistening  globules  are  seen ;  apparently  external  to 
the  cells  is  a  structureless  mass,  resting  upon  the 
dentine,  but  separated  from  it  by  what  appears  to  be 
a  membrane.  This  mass  becomes  the  enamel.  As 
the  ameloblastic  layer  recedes  from  the  dentine,  the 
oldest  portions  of  the  deposit  take  form  and  become 
enamel-prisms.  The  process  begins  about  the  sixth 
month  of  intra-uterine  life. 

10.  What  is  calcoglobulin? 

If  a  solution  of  a  calcium  salt  be  slowly  added  to 
a  solution  of  albumin,  the  calcium  unites  with  the 
albumin  in  small  glistening  microscopic  bodies, 
which  have  a  structure  similar  to  that  of  an  onion. 
These  globules  are  calcoglobulin.  They  are  mark- 
edly resistant  to  the  action  of  acids.  From  the 
globules  the  enamel  and  dentine  are  built. 

11.  Describe  the  dentinal  papilla. 

In  its  descent  into  the  substance  of  the  embryonic 
jaw,  the  epithelial  infolding  appears  to  meet  a  re- 
sistance which  forms  it  into  a  representation  of  the 
future  tooth.  The  outlined  portion  of  mesoblastic 
tissue  covered  by  this  formed  epithelial  cap  is  called 
the  dentinal  papilla. 

12.  What  are  its  peripheral  cells  called? 


DENTAL   PATHOLOGY   AND   THERAPEUTICS.       47 

As  soon  as  the  epithelial  boundary  cells  of  the 
enamel-org'an  assume  their  prismatic  form,  the 
boundary  cells  of  the  dentinal  papilla  become  ar- 
ranged in  a  layer,  called  the  odontoblasts.  Their 
function  is  the  formation  of  the  dentine, 

13.  How  is  dentine  formed? 

Masses  of  calcoglobulin  are  excreted  from  the 
ends  of  the  odontoblasts,  which  recede  as  the  de- 
posit occurs,  each  leaving  a  prolongation  in  the  de- 
posit, about  which  the  walls  of  the  dentinal  tubuli 
are  formed. 

14.  When  is  the  alveolar  process  formed? 

Its  development  is  coincident  with  that  of  the 
enamel  and  dentine. 

15.  How  is  the  inferior  maxilla  formed? 
Extending  from  the  embryonic  middle  ear  are 

two  rods  of  cartilage  acting  as  a  support  to  the 
arches  of  the  embryonic  lower  jaw.  These  are  the 
cartilages  of  Meckel.  They  are  surrounded  by  a 
mass  of  mesoblastic  tissue,  in  which  islands  of  cal- 
cification are  found,  which  coalesce,  and  become 
the  inferior  maxillary  bone. 

16.  How  are  the  superior  maxillary  _bones 
formed? 

The  right  and  left  visceral  arches  above  those 
forming  the  embryonic  lower  jaw  extend  forward, 
and  are  met  by  a  pair  of  processes  growing  down- 
ward from  the  frontal  projection.  These  latter, 
joining  the  lateral  projections,  form  the  upper  jaw. 
Any  failure  of  tne  parts  to  unite  with  one  another 
causes  hare-lip,  or  it  may  be  cleft  palate. 


48  COMPEND    OF  * 

17.  How  is  the  antrum  of  Highmore  formed? 
An  invagination  of  the  mucous  membrane  of  the 

middle  meatus  occurs,  which  marks  the  site  of  the 
nasal  opening  to  the  antrum;  the  interior  of  the 
bone  is  excavated  through  a  resorptive  process,  the 
cavity  being  lined  by  the  invaginated  mucosa,  which 
follows  the  direction  of  the  excavation. 

18.  How  is  cementum  formed? 

The  fibrous  layer  inclosing  the  developing  tooth 
becomes  a  periosteum;  it  is  at  the  extremity  of  the 
enamel-organ  in  contact  with  the  periphery  of  the 
dentinal  papilla.  A  layer  of  odontoblasts  abutting 
with  a  layer  of  cementoblasts  (osteoblasts),  the  de- 
velopment of  the  cementum  is  then  sub-periosteal. 

19.  How  are  the  teeth  erupted? 

The  progressive  growth  of  the  tooth-root,  to- 
gether with  the  alveolar  process  beneath  and  about 
it,  forces  the  tooth  outward,  its  apex  causing  ab- 
sorption, by  pressure,  of  the  overlying  tissues. 

20.  What  influences  affect  the  developing 
enamel? 

Many  of  the  conditions  affecting  general  nutri- 
tion. The  several  eruptive  fevers.  Scarlet  fever, 
smallpox,  measles,  being  forms  of  specific  derma- 
titis, the  teeth,  as  part  of  the  tegumentary  system, 
are  affected. 

21.  What  are  Hutchinson  teeth? 
Malformed  upper  central  incisors;  they  are  crude 

cones,  deeply  notched  upon  their  cutting-edges,  and 
are  evidences  of  hereditary  syphilis. 


dental  pathology  and  therapeutics.     49 

Malformations  of  the  Teeth. 

1.  What  are  malformed  teeth? 

Teeth  whose  outward  forms  or  whose  tissues 
vary  from  the  normal.  The  term  is  applied  alone  to 
gross  aberrations  from  the  normal  standard. 

2.  What  are  the  causes? 

Influences  which  affect  any  portion  of  the  tooth- 
follicle  at  any  period  of  its  growth.  Owing  to  un- 
known causes,  the  enamel-organ  may  assume  a  form 
entirely  different  from  the  typal  form,  and  the  entire 
tooth  may  have  its  form  widely  different  from  that 
of  a  normal  tooth.  Aberrations  in  the  formation  of 
the  roots  are  very  common.  An  enamel-organ  may 
partially  divide  into  two,  and  form  what  outwardly 
appear  to  be  double,  or  twin  teeth.  The  ce- 
mentum  of  two  adjoining  teeth  may  fuse. 

3.  What  evil  follows  upon  malformation  of  the 
teeth  as  regards  their  outward  forms? 

The  creation  of  pockets  about  and  between  the 
teeth,  which  retain  food  debris  and  become  the  seat 
of  lactic  fermentation. 

4.  What  histological  malformations  are  found? 

Deficiencies  of  enamel :  these  may  be  slight  or  ex- 
tensive; a  failure  to  perfectly  close  a  sulcus  or  pit; 
^nd,  on  the  other  hand,  teeth  forming  during  the  oc- 
currence of  one  of  the  eruptive  fevers  may  be  almost 
devoid  of  enamel.  The  general  structure  of  the 
enamel  may  be  faulty,  owing  to  imperfect  organiza- 
tion. The  dentine  may  contain  spaces  in  which  cal- 
cification has  not  occurred, — interglobular  spaces. 

8 


50  COMPEND    OF 

5.  Why  are  the  teeth  affected  by  the  eruptive 
fevers? 

These  diseases  are  ah  expressions  of  dermatitis; 
the  teeth,  as  dermoid  structures,  are  also  involved. 

Primary  Dentition. 

1.  What  is  meant  by  primary  dentition? 

The  cutting  of  the  temporary  or  milk  teeth;  the 
process  through  which  the  developing  temporary 
teeth  emerge  from  the  gum  and  assume  their  posi- 
tions in  a  dental  arch. 

2.  In  what  order  and  at  what  times  do  the  tem- 
porary teeth  emerge  through  the  gum? 

^     ^    ,  .     .  f   Lower,     s  to     7  mos. 

Central  mcisors |  ^pper,    7   "     8     " 

Lateral  incisors ]    L-^'    ^  L'     9     : 

(    Upper,    9        10 

X-.    ,        1  (    Lower,  11   "    12     " 

r  irst  molars ^    t  t         -         u  u 

\  Upper,  13        14 

CusDids  I   ^°'^'^^'  '7  "   18     " 

^^^P'"^^ 1  Upper,  19  "   20     " 

Second  molars 23   "   30     " 

These  are  the  average  periods.  Children  may  be 
born  with  teeth  erupted;  others  may  not  "cut" 
teeth  until  several  years  of  age. 

3.  Describe  the  process  of  eruption.  ■ 

The  partially-formed  teeth  are  within  the  sub- 
stance of  the  fibro-osseous  tissues  associated  with 
the  alveolar  process.  Above  are  the  dense  fibrous 
structures  of  the  gum;  these  nmst  be  pierced  to  free 


DENTAL   PATHOLOGY   AND    THERAPEUTICS,       5I 

the  tooth.  On  all  sides  is  the  developing  alveolar 
process.  Beneath,  the  partially-formed  root  con- 
tains a  large  pulp  mass  which  communicates  with 
the  vital  tissues  beneath  it;  the  periphery  of  the 
apical  foramen  is  now  the  periphery  of  the  root. 
The  developing  root  thrusts  the  apex  of  the  crown 
against  the  overlying  tissues,  which,  pressed  upon, 
undergo  resorption  as  the  crown  advances  until  the 
latter  emerges  through  the  gum. 

4.  What  may  be  said  of  this  process? 

Like  parturition,  that  although  a  physiological 
process,  pathological  manifestations  are  frequently 
noted. 

5.  What  are  some  of  the  manifestations  of  path- 
ological dentition? 

Local  disturbances,  irritative  stomatitis,  next 
more  general  disturbance  of  the  gastro-intestinal 
canal,  manifested  in  vomiting  and  diarrhea,  or  it 
may  be  by  obstinate  constipation;  skin  eruptions 
may  occur;  fever  is  not  uncommon,  and,  finally,  re- 
flex disturbances  associated  with  the  central  ner- 
vous system.  The  local  symptoms  are  frequently 
red  and  swollen  gums,  inability  to  nurse,  and  hyper- 
secretion of  saliva.  General  symptoms  may  appear 
without  any  evidences  of  local  disturbance,  the 
gums  not  being  inflamed.  It  is  probable  that  the 
backward  pressure  upon  the  pulp,  caused  by  the 
failure  of  tissue  removal  in  advance  of  the  crown, 
may  cause  the  symptoms  referable  to  the  central 
nervous  system. 


52  COMPEND    OF 

6.  What  is  the  severe  expression  of  these  reflex 
disturbances? 

Convulsions. 

7.  What  is  the  general  treatment  of  pathological 
dentition? 

Removal  of  the  source  of  irritation.  If  the  symp- 
toms are  mild,  a  piece  of  ice  wrapped  in  a  handker- 
chief is  given  the  child  to  suck  in  lieu  of  a  teething- 
ring.  Cases  not  relieved  by  such  means  usually  re- 
quire lancing. 

8.  How  is  this  done? 

The  incision  is  made  in  the  line  which  should  be 
occupied  by  the  cutting-edge  of  the  tooth.  Lower 
incisors  are  lanced  parallel  with  and  inside  the  cut- 
ting-edges of  the  teeth;  upper  incisors  to  the  out- 
side. The  lower  molars  and  the  upper  second 
molar  are  lanced  twice  diagonally  across  the  cusps. 
Upper  first  molars  are  lanced  crucially.  Cuspids 
are  lanced  first  as  incisors,  and  when  their  points 
have  emerged,  the  surrounding  ring  of  gum  is  di- 
vided at  two  points,  inside  and  outside. 

9.  Wliat  precautions  are  taken? 

The  blade  of  a  curved  bistoury  is  wrapped  with 
linen  until  its  point  alone  is  visible.  A  thumb  and 
finger  of  the  left  hand  are  placed  about  the  part  to 
be  incised.  An  assistant  holds  the  child  upon  his 
left  thigh,  his  right  hand  holding  the  child's  hands 
folded  across  the  abdomen,  the  legs  held  down  by 
the  right  arm;  the  assistant's  left  hand  steadies  the 
child's  head. 

10.  What  is  the  subsequent  danger,  and  how  is 
it  treated? 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       53 

Hemorrhage.  A  small  amount  of  bleeding  is 
serviceable.  It  is  checked  by  giving  the  child  a 
piece  of  ice  wrapped  in  linen  to  suclc,  touching 
the  bleeding  surface  with  phenol  sodique  or  other 
powerful  styptic.  The  case  is  to  be  examined  for 
oozing  hemorrhage. 

II.  At  what  periods  are  reflex  disturbances  most 
common? 

The  second  summer,  because  winter-born  chil- 
dren cut  their  cuspids  (four)  and  summer-born  chil- 
dren their  first  or  second  molars  at  this  period. 
(Flagg.) 

12. .   What  is  the  primary  reason  for  this? 

These  teeth  are  commonly  cut  four  at  a  time. 

13.  What  other  influence  is  present? 

The  alimentary  tract  is  kept  in  a  condition  of  ir- 
ritation at  a  period  when  cholera  infantum  prevails. 

14.  What  is  the  treatment  of  teething  convul- 
sions? 

Immerse  the  child  to  the  waist  in  hot  water;  place 
cold  water  upon  the  head.  In  five  minutes  adminis- 
ter a  rectal  injection  of  a  drachm  of  glycerol.  As 
soon  as  the  bowels  have  moved  give  rectal  injection: 

R — Hydrat.  chlor.,  gr.  iij; 
Sodii  brom.,  gr.  v; 
Sol.  starch,  oz.  ij. — M^ 

The  gum  over  the  teeth  which  should  be  erupt- 
ing is  incised,  whether  indications  of  inflammation 
be  present  or  not. 

15.  What  is  the  treatment  of  caries  in  tempo- 
rary teeth? 


54  COMPEND    OF 

Excavate  as  thoroughly  as  possible,  keep  the 
parts  dry  by  means  of  napkins,  syringe  with  hydro- 
gen peroxid.  Upon  articulating  faces  of  the  teeth 
fill  with  zinc  phosphate.  Small  cavities  may  be  filled 
with  tin  or  amalgam.  Approximal  cavities  are 
usually  to  be  filled  with  gutta-percha.  Shallow  cav- 
ities in  which  undercuts  cannot  be  secured  are 
touched  with  nitrate  of  silver  after  excavating. 

1 6.  Of  what  great  importance  is  the  early  and 
systematic  treatment  of  the  temporary  teeth? 

By  checking  caries  before  the  pulp  is  involved, 
there  is  not  that  interference  with  the  resorption  of 
roots  which  follows  upon  death  of  the  pulp ;  further- 
more, septic  processes  do  not  occur. 

17.  What  is  the  resorption  of  roots? 

A  physiological  process  through  which  the  roots 
of  the  temporary  teeth  are  removed,  as  the  perma- 
nent teeth  which  lie  beneath  them  advance  toward 
eruption. 

t8.  What  dangers  are  to  be  apprehended  from 
abscess  upon  temporary  teeth? 

The  immediate  danger  is  a  possible  involvement 
of  the  follicle  of  the  permanent  tooth  in  the  process 
of  suppuration.  Abscess  upon  temporary  teeth  is 
frequently  associated  with  septic  intoxication.  The 
remote  danger  is  interference  with  root  resorption; 
the  process  is  abortive  in  pulpless  teeth. 

19.  What  is  the  treatment  of  pulpless  and  septic 
temporary  teeth? 

Free  entrance  to  the  canals;  a  thorough  washing 
with  pyrozone.     The   canals   are   then   filled   with 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.   55 

Balsamo  del  Deserto,  and  the  carious  cavity  with 
gutta-percha. 

20.  What  is  the  treatment  of  acute  abscess  upon 
temporary  teeth  ? 

Early  and  free  entrance  to  the  pulp-canals,  wash- 
ing with  antiseptics,  and  early  incision  of  the  swell- 
ing upon  the  gum. 

21.  What  are  the  objections  to  the  extraction  of 
temporary  teeth? 

It  interferes  with  the  normal  enlargement  of  the 
jaws,  and  may  mechanically  injure  the  developing 
permanent  teeth.  Too  long  retained,  the  tempo- 
rary teeth  may  cause  malpositions  of  the  permanent 
teeth.  In  grave  septic  inflammations  the  early  re- 
moval of  the  affected  tooth  is  demanded. 

Eruption  of  the  Permanent  Teeth. 

1.  What  are  the  periods  of  eruption  of  the  per- 
manent teeth? 

First  molars,  si  to  7  years. 
Central  incisors,  6  to  8  years. 
Lateral  incisors,  7  to  9  years. 
First  bicuspids,  9  to  10  years. 
Second  bicuspids,  10  to  12  years. 
Second  molars,  12  to  14  years. 
Cuspids,  13  to  15  years. 
Third  molars,  17  to  45,  or  even  60  years. 
Lower  teeth,  as  a  rule,  precede  the  upper  by  a  few 
months. 

2.  What  peculiarities  associate  with  the  eruption 
of  the  permanent  teeth? 


56  COMPEND    OF 

Malpositions,  treated  of  under  the  head  of  Ortho- 
dontia. The  absence  of  teeth.  Cases  are  common 
in  which  no  upper  lateral  incisors  are  formed. 
Delayed  eruption,  and  teeth  which  have  been  devel- 
oped in  such  positions  as  to  permanently  prevent 
eruption  (encysted  teeth). 

3.  With  w^hat  teeth  is  pathological  dentition 
common? 

The  lower  third  molars. 

4.  What  is  the  common  cause  of  the  difficult 
eruption  of  the  lower  third  molars? 

Lack  of  space  between  the  ramus  of  the  inferior 
maxillary  bone  and  the  posterior  wall  of  the  second 
molar.  The  eruption  is  also  delayed  on  account  of 
the  density  of  the  bony  structures  about  the  tooth. 

5.  What  are  the  usual  evidences  of  abnormal 
eruption? 

Inflamed  and  tumid  gums;  ill-defined  pains  about 
the  parts,  often  becoming  acute;  more  or  less  dififi- 
cvdty  in  opening  the  jaws,  leading  upon  the  part  of 
the  patient  to  the  belief  that  trismus  is  imminent. 
Severe  symptoms  may  appear  and  septic  processes 
occur  before  the  appearance  of  the  crown.  Exten- 
sive inflammatory  disturbances  are  far  from  com- 
mon, the  neighboring  parts  participating. 

6.  What  is  its  treatment? 

Depends  upon  the  conditions.  If  a  flap  of  gum 
overlies  the  almost  emerged  crowns,  the  mouth  is 
sterilized  and  the  flap  excised.  If  the  tooth  be  par- 
tially imprisoned  by  gum,  the  latter  is  incised 
freely;  a  crucial  incision  may  be  required.     In  se- 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.        57 

vere  cases,  in  which  it  is  evident  that  the  tooth  is 
firmly  impacted  between  the  ramus  of  the  jaw  and 
the  second  molar,  the  latter  tooth  is  to  be  extracted. 
Marked  general  symptoms  may  require  treatment. 
The  administration  of  morphia  may  be  indicated, 
but  it  is  preferable  to  employ  gr.  x  of  ammonol  and 
give  sulfonal  as  a  hypnotic  when  required.  The 
removal  of  large  flaps  may  be  accomplished  pain- 
lessly by  injecting  the  parts  with  about  1-16  gr.  co- 
cain  in  a  large  volume  of  listerine  and  water. 
Tense  flaps  may  be  removed  through  applications 
of  trichloracetic  acid,  full  strength. 

7.  Which  of  the  permanent  teeth  is  of  greatest 
clinical  importance? 

The  first  permanent  molar.  First,  on  account  of 
its- function,  it  acts  as  a  bulwark  which,  when  re- 
moved, interferes  with  the  general  dentition.  Its 
sulci  and  pits  are  the  situations  in  which  caries  is 
first  found. 

Diseases  of  the  Enamel. 

1.  What  is  the  relation  of  enamel  to  disease 
causes? 

When  fully  formed  it  is  passive. 

2.  To  what  diseases  is  it  subject? 
Malformations,  due  to  errors  of  development;  it 

is  the  seat  of  deposits  of  fungi  and  calculi,  and  sub- 
ject to  chemical  solution  through  the  action  of 
acids, 

3.  How  are  malformations  of  enamel  divided? 
Into     topographical     and     histological.      Topo- 

9 


58  COMPEND    OF 

graphical  malformations  affect  the  general  form  of 
the  enamel-cap;  they  are  termed  anomalies.  His- 
tological malformations  are  characterized  by  an  ex- 
cess or  deficienc}^,  usually  the  former,  of  the  enamel- 
cap, 

4.  What  are  the  prominent  causes  of  the  most 
pronounced  of  these  affections? 

The  occurrence  of  the  eruptive  diseases  at  the 
time  the  enamel  is  developing.  Smallpox,  scarlet 
fever,  measles,  are  all  forms  of  specific  dermatitis, 
so  that  the  teeth,  as  dermoid  structures,  are  affected. 
Syphilis  of  the  infant  causes  topographical  mal- 
formation of  tooth-crowns. 

5.  How  are  these  latter  teeth  named? 

Hutchinson  teeth.  The  permanent  central  inci- 
sors are  dwarfed,  notched,  and  in  some  cases  coni- 
cal; they  are  regarded  as  pathognomonic  of  hered- 
itary syphilis, 

6.  What  is  another  distinct  cause  of  malforma- 
tions? 

Mechanical  violence  to  the  dental  follicle  during 
tooth-formation. 

Green-Stain, 

I.     What  is  green-stain? 

The  term  is  usually  applied  to  the  green  deposits 
covering  the  cervical  portion  of  the  enamel  of  chil- 
dren's teeth,  the  upper  anterior  teeth  being  most 
commonly  affected  more  than  the  other  teeth.  Its 
common  situation  is  in  the  cervical  remnants  of  the 
enamel-cuticle. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       59 

2.  What  is  its  origin? 

In  great  part  due  to  the  growth  of  fungi  in  the 
remnants  of  the  enamel-cuticle.  The  coloring  mat- 
ter is  not  chlorophyll.  It  is  usually  found  asso- 
ciated with  soft  white  deposits  in  ill-kept  mouths; 
the  enamel  surfaces  to  which  the  stain  is  at- 
tached are  roughened,  probal)ly  before  the  deposits 
of  green-stain  are  formed. 

3.  What  is- its  effect  upon  the  enamel? 
Apparently    not    injurious;     the     roughness     of 

enamel  found  beneath  the  deposits  is  probably  the 
partial  cause  rather  than  the  effect  of  the  deposits. 

4.  What  is  its  treatment? 

The  removal  of  the  deposits  and  the  polishing  of 
the  rough  enamel  surfaces  by  means  of  abrasives, 
followed  by  increased  hygienic  precautions. 

5.  What  are  other  causes  of  colored  deposits 
upon  the  enamel? 

Staining  by  metallic  salts, — copper,  iron,  man- 
ganese, mercury,  and  nickel. 

Diseases  of  the  Dentine  and  Pulp. 

1.  Into  what  two  classes  are  affections  of  the 
dentine  divided? 

Into  constructive  and  destructive. 

2.  With  what  organ  is  the  first  class  asso- 
ciated? 

With  the  dental  pulp. 

3.  What  are  the  functions  of  the  dental  pulp? 
They  are  formative  and  sensory. 

4.  How  is  formative  activity  evinced? 


60  COMPEND    OF 

Originally,  in  the  formation  of  dentine;  abnor- 
mally, in  secondary  growths  of  dentine,  which  may 
obliterate  the  dentinal  tubules;  from  protuberances 
or  excrescences  upon  any  portion  of  the  wall  of 
the  pulp-chamber;  or,  again,  the  products  of  secon- 
dary activity  may  exist  as  deposits  in  the  substance 
of  the  pulp  itself.  These  are  the  constructive  affec- 
tions of  dentine. 

5.  What  is  the  sensory  function  of  the  pulp? 
The  pulp  of  a  tooth  is  not  its  tactile  organ;  the 

sense  of  touch  resides  in  the  pericementum.  The 
stimuli  to  which  a  pulp  normally  responds  are  ther- 
mal changes,  applications  of  hot  and  cold  provoking 
painful  response.  Mechanical  and  chemical  irri- 
tants affect  the  pulp,  and  cause  painful  response 
when  the  dentine  is  deprived  of  enamel. 

6.  What  is  the  peculiarity  of  pulp  pain? 

Like  all  other  organs  in  which  the  tactile  sense  is 
normally  absent,  irritation  caused  in  it  gives  rise  to 
pain  which  is  referred  to  some  other  part.  Pain 
arising  from  disorders  of  the  dentine  or  pulp  is 
rarely  localized,  but  is  reflected  to  some  other 
branch  of  the  great  nerve-trunk  supplying  the  pulp. 

7.  Of  what  special  value  is  a  knowledge  of  this 
fact? 

It  furnishes  a  means  of  diagnosis  between  affec- 
tions of  the  pulp  and  those  of  the  pericementum. 
A  tooth  which  is  sore  to  the  touch  has  its  peri- 
cementum, not  its  pulp,  affected.  Paroxysms  of 
pain  caused  by  the  taking  of  cold  substances  in  the 
mouth  have  their  origin  in  a  disorder  of  the  pulp. 


DENTAL    PATHOLOGY    AND    TPIERAPEUTICS.       6l 

8.     How  are  these  dentinal  deposits  designated? 

Those  obHterating-  the  tubules  are  called  tubular 
calcification.  Occupying  the  wall  of  the  pulp- 
chamber,  they  are  known  as  deDOsits  of  secondary 
dentine;  if  found  in  the  substance  of  the  pulp  itself, 
they  are  called  pulp-nodules. 

q.     What  is  the  general  cause  of  these  deposits? 

A  mild  and  continued  irritation  of  the  ]n\\p  trans- 
mitted to  it  through  the  contents  of  the  dentinal 
tubuli  leads  to  formative  reaction  upon  the  part  of 
the  pulp. 

10.  What  are  the  most  common  causes  of  the 
irritation? 

The  irritation  produced  by  the  invasion  of  caries; 
second,  the  presence  of  metallic  fillings  close  to  the 
pulp,  which,  owing  to  their  high  conductivity,  cause 
irritation  through  thermal  stimuli. 

11.  What  is  meant  by  irritation  of  the  pulp? 

A  degree  of  stimulus  which  exalts  the  general 
functions  of  the  organ. 

12.  What  are  the  two  sources  of  irritation  to  the 
pulp? 

Extrinsic  and  intrinsic. 

13.  What  are  the  chief  of  these  classes? 
Intrinsic   causes:    secondary    deposits   upon   the 

periphery  or  in  the  substance  of  the  pulp.  Extrin- 
sic causes :  exposure  of  the  pulp,  through  the  prog- 
ress of  caries,  permitting  the  access  of  irritants  to 
parts  which  normally  are  well  protected. 

14.  How  soon  may   pulp-irritation  be   said  to 


62  COMPEND    OF 

As  soon  as  the  loss  of  enamel  exposes  the  con- 
tents of  the  tiibuli,  these  being  the  terminals  of  the 
peripheral  cells  of  the  pulp. 

15.  What  is  the  range  of  pulp-irritation? 
From  mild  stimulation  to  necrosis. 

16.  What  are  the  effects? 

They  depend  upon  the  degree  of  irritation,  the 
extent  and  grade  of  vascular  disturbance.  Stimu- 
lation is  productive  of  secondary  growth;  the 
functions  of  the  cells  are  exalted.  More  marked 
irritation  probably  tends  to  the  formation  of  nodu- 
lar deposits  or  other  formative  structural  changes. 
The  higher  grades  of  vascular  excitement  produce 
alterations  in  the  vessels  of  the  pulp,  minute  aneur- 
isms; general  inflammation  of  the  pulp  commonly 
produces  necrosis  of  the  organ.  Suppuration  and 
ulceration  of  the  pulp  are  later  stages. 

17.  What  usually  determines  the  degree  and  ex- 
tent of  vascular  disturbance? 

The  depth  of  invasion  of  the  carious  process. 

18.  Give  a  more  detailed  description  of  the  con- 
nection between  caries  and  functional  and  organic 
pulp  disturbances. 

When  the  carious  process  invades  the  outer  layers 
of  dentine,  the  pulp  is  stimulated,  and  attempts  the 
formation  of  a  barrier  to  the  advance  of  the  dis- 
ease. Later,  the  source  of  irritation  approaching 
the  pulp,  greater  functional  disturbance  results, 
until  irritating  matters,  principally  micro-organisms 
and  their  waste  products,  gain  access  to  the  pulp. 
With  exposure  of  the  organ,  the  pyogenic  cocci, 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       63 

always  present,  find  an  entrance,  and  suppuration 
ensues, 

19.  What  is  the  symptom  most  frequently  noted 
as  accompanying  the  progress  of  dental  caries? 

Pain. 

20.  Prior  to  near  exposure  of  the  pulp,  what  is 
the  source  of  the  pain? 

Irritation  of  the  contents  of  the  dentinal  tubuli, 
called  hypersensitivity  of  dentine. 

21.  How  soon  does  this  symptom  appear? 

As  soon  as  dentine  is  exposed.  It  occurs  through 
exposure  of  dentine  at  the  base  of  enamel-fissures, 
upon  the  worn  surfaces  of  teeth,  and  at  the  necks  of 
the  teeth  as  soon  as  the  cementum  is  lost, 

22.  What  are  the  symptoms  of  hyperesthesia  of 
the  dentine? 

Reflex  pain;  if  an  upper  tooth,  referred  to  some 
portion  of  the  distribution  of  the  superior  maxillary 
nerve ;  if  a  lower  tooth,  referred  along  the  course  of 
the  inferior  maxillary  nerve. 

23.  How  is  the  symptom  elicited? 

By  the  introduction  of  salt,  acid,  or,  particularly, 
sweet  substances  to  the  exposed  dentine;  again,  by 
the  touch  of  an  instrument,  pain  is  produced 
through  the  contact  of  the  instrument,  and  ceases 
when  the  latter  is  removed. 

24.  What  is  the  probable  mode  of  transmission 
of  the  pain? 

The  impression  is  received  through  the  contents 
of  the  dentinal  tubuli,  transmitted  to  the  odonto- 
blasts, and  through  these  cells  to  the  terminal  fila- 


64  COMPEND    OF 

merits  of  the  plexus  of  non-medullated  nerve-fibers 
which  underlie  the  odontoblasts. 

25.  What  is  the  method  employed  to  destroy 
the  hyperesthesia? 

By  benumbing  or  destroying  the  contents  of  the 
dentinal  tubuli. 

26.  What  two  classes  of  drugs  are  employed  for 
the  purpose? 

Coagulating  cauterants,  such  as  zinc  chlorid, 
carbolic  acid,  creasote,  trikresol,  or  the  actual 
cautery.  Analgesic  agents,  such  as  the  oils  of 
cloves,  cinnamon,  thymol;  or  the  sedative  alkaloids, 
cocain,  morphia,  aconitia,  atropia,  and  veratria. 

27.  What  other  means  are  employed  for  the  pur- 
pose? 

First,  through  a  limited  desiccation  of  dentine  by 
means  of  blasts  of  warm  air;  next,  through  the  ac- 
tion of  agents  which  abstract  water  from  the  tis- 
sues,— zinc  chlorid,  chromic  acid,  solutions  of  tan- 
nin in  glycerol;  sodium  carbonate,  or  sodium 
peroxid;  or,  again,  by  the  action  of  the  stronger 
mineral  acids. 

28.  What  rule  should  govern  the  application  of 
these  remedies? 

The  more  shallow  the  carious  cavity,  the  more 
powerful  may  be  the  agent  employed;  and,  vice 
versa,  as  the  carious  process  approaches  the  pulp, 
the  analgesics  are  substituted  for  the  cauterants. 

29.  In  what  order  may  they  be  employed  for 
obtunding  hyperesthetic  dentine? 

Beginning   with   exposure   of   the   most    super- 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       65 

ficial  layers  of  dentine,  nitric  or  sulfuric  acid;  next, 
chromic  acid  or  zinc  chlorid;  following  these,  the 
phenyls,  carbolic  acid,  creasote,  and  trikresol;  next, 
the  analgesic  oils  and  the  alkaloids. 

30.  Should  they  always  be  applied  in  the  order 
given  ? 

No;  the  milder  agents  are  first  applied,  and  the 
stronger  eschewed,  unless  the  milder  are  found  in- 
effective. 

31.  What  agent  is  unqualifiedly  to  be  con- 
demned as  an  obtundent? 

Arsenious  oxid,  or  cobalt  (which  contains  ar- 
senic). 

32.  What  agent  and  means  give  promise  of 
greatest  success  as  an  obtundent? 

A  mixture  of  cocain  in  guaiacol  driven  into  the 
dentine,  or,  if  required,  into  the  dental  pulp  and 
beyond  it,  by  means  of  a  cataphoretic  current. 

33.  What  is  the  second  cause  of  odontalgia  af- 
fecting the  dental  pulp? 

Irritation  of  the  pulp,  through  the  deep  invasion 
of  caries. 

34.  What  are  the  prominent  causes  of  pain  in 
this  connection? 

Acid  products  of  fermentation;  mechanical 
causes,  producing  pressure  upon  the  layer  of  den- 
tine covering  the  pulp;  and  thermal  changes,  pro- 
ducing irritation. 

35.  What  is  the  nature  of  the  pain? 
Depends  upon  the  degree  of  irritation.     If  com- 
paratively  mild,   a  steady,   gnawing   pain   is   felt. 


66  COMPEND  OF 

usually  referred  to  the  immediate  region  of  the  af- 
fected tooth.  If  active  hyperemia  of  the  pulp  be 
present,  the  pain  may  be  throbbing;  this  variety  of 
pain  is,  however,  unusual,  common  though  it  is  in 
the  succeeding  grade  of  irritation.  Applications  of 
cold  provoke  pain;  the  pain  induced  by  the  applica- 
tion of  heat  is  less  pronounced. 

36.  What  are  the  succeeding  grades  of  pulp  irri- 
tation? 

Hyperemia,  active  and  passive;  inflammation, 
suppuration,  and  gangrene.     (See  after  Caries.) 

1.  What  are  the  destructive  affections  of  the 
dentine? 

Dental  caries,  erosion,  and  an  extremely  rare 
affection,  resorption  of  the  dentine. 

2.  What  is  meant  by  resorption  of  dentine? 

A  loss  of  dentine,  progressing  from  the  periphery 
of  the  pulp-chamber  toward  the  enamel.  It  is  a 
resorptive  process  by  the  dental  pulp. 

3.  What  are  its  symptoms? 

None,  or  very  vague,  until  the  resorption  has 
proceeded  so  far  as  to  enable  the  operator  to  see  the 
pink  pulp  through  its  translucent  enamel  covering. 

4.  What  is  its  prognosis? 
Data  are  wanting. 

5.  What  is  its  therapeutics? 

An  alterative  tonic,  arsenic  iodid,  administered  to 
a  patient  presenting  this  condition,  resulted  in  a 
constructive  process  which  replaced  the  dentine  lost 
through  the  retrograde  metamorphosis.     (Kirk.) 

(Erosion  is  discussed  later.) 


dental  pathology  and  therapeutics,     6/ 

Dental  Caries. 

1.  What  is  dental  caries? 

A  gradual  decay  of  the  tissues  of  a  tooth,  always 
proceeding  from  the  periphery  toward  the  pnlp. 

2.  How  are  its  causes  divided? 
Into  predisposing  and  exciting. 

3.  What  are  its  predisposing  causes? 

Local,  and  perhaps  constitutional.  The  local 
causes  are  faults  of  structure,  form,  and  positions  of 
the  teeth,  forms  and  positions  which  permit  the 
massing  and  retention  of  food  debris;  faulty  struc- 
ture permits  the  rapid  invasion  of  the  carious  pro- 
cess. Constitutional  states  expressed  by  lowered 
vital  tone  appear  to  permit  the  more  rapid  multipli- 
cation of  the  exciting  cause  of  caries.  Areas  of  de- 
fective calcification  in  the  dentine,  known  as  inter- 
globular spaces,  furnish  situations  which  favor  the 
rapid  extension  of  the  carious  process. 

4.  What  is  this  exciting  cause? 

Micro-organisms,  which  produce  lactic  fermenta- 
tion ;  through  their  action  carbohydrates  are  decom- 
posed into  lactic  acid,  which  acts  as  a  chemical  sol- 
vent. 

5.  To  whom  are  we  indebted  for  the  determina- 
tion of  this  fact? 

To  Dr.  W,  D.  Miller.  The  theory  of  solution 
through  the  action  of  acids  was  followed  by  that  of 
fermentation  as  the  cause  of  caries.  It  was  Dr. 
Miller  who  first  demonstrated  the  origin  and  mode 
of  action  of  the  solvent,  and  who  first  produced 
actual  artificial  caries. 


68  COMPEND    OF 

6.  What  is  the  morbid  anatomy  of  dental  caries? 
A  break  of  any  extent  in  the  continuity  of  enamel, 

exposing  an  area  of  dentine.  The  latter  tissue  is 
cupped  out,  destroyed  over  a  greater  or  less  area, 
the  concavity  containing  fermenting  masses  of  food 
debris.  Beneath  these  masses  the  dentine  is  decal- 
cified, soft,  and  almost  structureless;  the  under  sur- 
face of  the  enamel-walls  overlying  the  carious  cav- 
ity is  eroded.  Beneath  the  structureless  portions  of 
dentine  the  latter  tissue  has  its  tubuli  invaded  by 
and  filled  with  micro-organisms.  A  constant  fea- 
ture of  this  invasion  is  a  progressive  widening  of 
the  dentinal  tubuli.  The  depth  of  invasion  of  the 
organisms  is  far  in  advance  of  any  perceptible 
softening. 

7.  What  is  the  pathology  of  dental  caries? 

The  specific  organisms  of  lactic  fermentation 
gain  access  to  the  dentine,  either  through  a  solution 
of  the  overlying  enamel  by  lactic  acid,  the  waste 
product  of  the  organisms,  or  by  defects  of  the 
enamel  permitting  the  ingress  of  the  ferment  to 
the  dentine.  The  food  of  these  organisms  is  the 
debris  of  carbohydrates.  The  waste  product  of  the 
organisms  is  lactic  acid.  The  acid  attacks  the  den- 
tine, forming  the  lactate  of  calcium.  The  latter 
chemical  phenomenon  removes  the  free  lactic  acid 
from  about  the  organisms  and  permits  their  further 
growth,  checked  or  destroyed  if  an  excess  of  their 
waste  products  accumulates  about  them.  The  or- 
ganisms advancing  by  way  of  the  tubuli,  their 
waste  product  decalcifies  the  sheaths  of  the  dentinal 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       69 

tubtili,  enlarging  the  tubuli  until  they  merge  into 
one  another.  The  invasion  of  the  transverse 
processes  of  the  tnbuli  is  secondary.  In  decalcify- 
ing the  carious  dentine,  lactic  fermentation  is  suc- 
ceeded by  fermentations  of  other  varieties,  notably 
butyric  fermentation,  this  being  followed  by  putre- 
factive decomposition.  A  usual  associate  of  the  in- 
vasion of  caries  is  pigmentation,  this  probably  due 
to  the  chromogenic  (color-producing)  organisms. 
Many  varieties  of  organisms  find  a  suitable  soil  of 
development  in  the  mass  of  carious  dentine. 

8.  What  are  the  signs  and  symptoms  of  dental 
caries? 

The  signs  are  cavities,  detected  either  by  actual 
observation  or  by  means  of  appropriate  instruments, 
called  explorers.  The  symptoms  are  pain  and  usu- 
ally odor.  The  pain  may  be  reflected  along  any 
part  of  the  course  of  the  fifth  cranial  nerve.  The 
odor  of  caries  is  distinctive. 

9.  What  is  its  clinical  history? 

In  the  order  of  frequency  caries  attacks,  first,  pits, 
grooves,  and  fissures  in  the  enamel;  second,  the  ap- 
proximal  surfaces  of  the  teeth;  third,  smooth  but 
unclean  surfaces;  fourth,  necks  of  the  teeth,  at  the 
enamel  border.  The  occurrence  is  governed  by  the 
presence  or  absence  of  spaces  in  which  lactic  fer- 
mentation may  proceed.  Pits  and  depressions  first 
exposed  and  attacked  are  those  upon  the  articulat- 
ing faces  of  the  first  permanent  molars.  The  next 
teeth  exposed  which  ofifer  spaces  in  which  lactic  fer- 
mentation   may    proceed    are    the    upper    incisors. 


70  COMPEND    OF 

Any  defects  or  pits  in  these  crowns  offer  a  fitting 
space  for  the  retention  of  organisms,  so  that  the  bas- 
ilar pit,  when  deep,  is  nsnaUy  attacked.  The  second 
permanent  molars  are  next  in  order,  the  fissures 
forming  the  retaining  spaces.  Next  the  approx'mal 
surfaces  of  the  upper  bicuspids;  and  if  the  fissures 
upon  their  articulating  faces  are  deep,  they  are  in- 
vaded. Following  these  are  the  approximal  sur- 
faces of  the  lower  second  bicuspid;  next  the  upper 
cuspid;  next  the  buccal  surfaces  of  the  teeth  and 
the  crowns  of  the  third  molars;  next  the  lower 
bicuspid,  and  last  the  lower  anterior  teeth.  The 
student  will  note  that  these  situations  are  such  that 
the  mechanical  cleansing  by  the  movement  of  the 
tongue,  cheeks,  and  saliva  is  of  decreasing  effective- 
ness; therefore  the  organisms  of  lactic  fermenta- 
tion and  their  soil  (food  debris)  are  retained  in  con- 
tact with  the  teeth. 

lo.     What  is  the  diagnosis  of  caries? 

Fine  explorers  of  various  shapes  are  pressed  into, 
first,  the  fissures  and  pits  of  the  teeth,  next  between 
and  over  their  approximal  surfaces.  Caries  is  de- 
tected by  the  edge  of  the  explorer  sinking  into  cavi- 
ties or  passing  over  softened  areas  of  the  enamel. 
The  approximal  spaces  are  further  tested  by  passing 
across  their  walls  floss  silk;  as  a  rule,  if  it  is  not 
frayed  or  torn,  the  enamel  surfaces  are  intact. 
Painful  sensations  following  the  introduction  of  salt, 
sweet,  or  acid  substances  in  the  mouth  indicate  ex- 
posure of  the  dentine,  and  search  is  made  by  means 
of  explorers  for  minute  cavities,  fissures,  or  defective 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       7I 

edges  of  fillings.  Any  space  in  which  the  point  of 
a  fine  explorer  sinks  is  to  receive  attention.  Caries 
in  teeth  containing  fillings  is  usually  indicated  by 
bluish  discoloration  of  a  tooth- wall  overlying  the 
filling. 

II.     What  is  the  prognosis? 

As  a  general  rule,  favorable;  the  results  depend- 
ing largely  upon  the  skill  with  which  the  indicated 
therapeutics  is  applied.  The  less  extensive  the 
process  in  a  denture,  and  the  less  deep  its  invasion 
in  individual  teeth,  the  better  is  the  prognosis. 

Therapeutics  of  Caries. 

1.  What  is  the  therapeutics  of  dental  caries? 
The  general  therapeutics  is  the  removal  of  the 

infected  material  and  the  unsupported  enamel 
walls,  and  their  replacement  by  materials,  insoluble 
in  the  fluids  of  the  mouth,  which  shall  serve  to  re- 
store the  lost  form  of  the  tooth,  seal  the  cavity  her- 
metically, and  sustain  the  stress  of  mastication. 

2.  Is  it  necessary  to  remove  all  of  the  infected 
dentine? 

Not  ahvays;  but  the  greater  amount,  at  least  all 
evidently  softened  portions,  should  be  removed,  and 
the  walls  subjected  to  contact  of  germicides  which 
shall  serve  to  sterilize  the  infected  portions  of  den- 
tine which  have  not  been  removed. 

3.  Why  is  this  invaded  structure  suffered  to 
remain  ? 

Exquisite  hypersensitivity  of  the  dentine  may 
prevent  or  render  inadvisable  thorough  excavation ; 


72  COMPEND    OF 

it  is  quite  possible  to  perfectly  sterilize  the  infected 
tissue,  and  it  serves  as  a  non-conducting  protective 
covering-  to  the  dental  pulp. 

4.  What  is  the  importance  of  the  non-conduct- 
ing layer? 

The  dental  pulp  is  singularly  intolerant  of  stimuli 
due  to  thermal  changes.  A  pulp  habitually  receiv- 
ing such  stimuli  becomes  the  seat  of  structural 
changes,  frequently  of  nodular  deposits  in  its  sub- 
stance, or,  it  may  be,  entire  calcification  about  the 
tissues  of  the  pulp. 

5.  What  are  the  degrees  of  caries,  and  why  is 
this  distinction  of  degrees  made? 

Superficial,  deep-seated,  and  complicated;  each 
stage  requires  special  treatment. 

6.  What  is  the  general  treatment  of  the  first 
grade? 

The  thorough  removal  of  infected  and  softened 
tissues,  and  their  replacement  by  a  physically 
perfect  filling. 

7.  What  is  meant  by  a  perfect  filling? 

It  is  chemically  unchangeable  in  the  fluids  of  the 
mouth;  is  a  non-conductor;  is  perfectly  adaptable  to 
the  walls  of  prepared  cavities;  is  susceptible  of  a 
perfectly  smooth  finish,  and  is  unchangeable  as  to 
its  form;  possesses  sufficient  strength  to  resist  the 
stress  of  mastication,  and  is  of  harmonious  color. 

8.  Which  of  all  the  filling-materials  possesses 
these  characteristics  in  highest  degree? 

Gold. 

9.  To  what  causes  is  the  failure  of  gold  as  a 
filling-material  attributed? 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.   J^) 

The  most  common,  and  believed  by  some  to  be 
the  universal  cause,  is  faulty  adaptation.  Owing  to 
lack  of  skill  or  care  upon  the  part  of  the  operator, 
the  filling-material  is  not  perfectly  adapted  to  the 
margins  of  the  cavity,  or  else  these  margins  are 
improperly  prepared.  The  next  cause  is  such  a 
structure  of  the  enamel  as  renders  the  perfect  adap- 
tation of  gold  to  margins  impossible. 

10.  What  is  the  treatment  of  the  second  stage  or 
degree  of  caries? 

The  removal  of  infected  tissues  and  weakened 
structures;  thorough  sterilization  of  the  dentine; 
covering  the  walls  of  the  dentine  with  a  substance 
wTiich  shall  prevent  irritation  of  the  pulp  through 
thermal  changes;  and  perfectly  filling  the  cavity,  as 
in  the  first  grade. 

11.  What  is  the  treatment  of  the  third  stage  of 
caries? 

This  grade  of  caries  ranges  from  almost  to  com- 
plete exposure  of  the  dental  pulp.  If  the  pulp  be 
not  exposed,  it  is  usual  to  remove  all  of  the  decalci- 
fied and  infected  dentine  except  that  acting  as  the 
immediate  pulp-covering.  This  layer  is  to  be  per- 
fectly sterilized  by  means  of  non-coagulating  anti- 
septics; any  undue  sensitivity  which  exists  should 
be  subdued -by  means  of  sedatives;  a  layer  of  a 
non-irritating  material  should  be  placed  over  the 
softened  area;  over  this  a  non-conducting  cavity- 
lining,  over  which  a  filling  is  to  be  placed. 

12.  What  antiseptics  are  to  be  preferred  in  this 
connection? 


74  COMPEND    OF 

25  per  cent,  pyrozone,  oil  of  cinnamon,  and  solu- 
tions of  thymol. 

13.  Why  are  the  latter  employed? 
They  are  both  analgesic  and  antiseptic. 

14.  What  pulp-protective  is  to  be  preferred? 
First,  a  film  of  one  of  the  ethereal  varnishes;  over 

this  a  thin  layer  of  oxysulfate. 

15.  What  cavity-linings  are  employed? 
Zinc  phosphate  and  the  oxychlorid  of  zinc. 

16.  Why  is  the  latter  not  used  as  a  pulp- 
capping? 

When  freshly  mixed,  and  for  some  time  succeed- 
ing, it  is  irritating  to  the  pulp,  and  may  produce  im- 
mediate irritation  or  midesirable  results  in  the 
future. 

17.  What  effects  are  desired  after  this  treat- 
ment? 

First,  that  a  recalcification  of  the  softened  dentine 
shall  occur;  second,  that  the  softened  layer  may  re- 
main unchanged  indefinitely  and  be  perfectly  neu- 
tral as  to  its  efifects. 

18.  What  results  may  follow  the  application  of 
irritating  linings? 

A  functional  activity  of  the  pulp  may  be  produced 
which  shall  cause  dentinal  deposits  in  or  about  the 
pulp;  theoretically,  it  is  desirable  that  a  restoration 
or  recalcification  of  the  softened  dentine  should 
occur,  but  there  is  no  means  of  limiting  or  gauging 
the  extent  of  nutritive  activity  which  may  be  pro- 
duced. 

19.  W'hat  is  the  next  grade  of  dental  caries? 
That  in  which  the  pulp  is  exposed. 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       75 

20.  What  are  the  usual  results  in  nearly-exposed 
pulps  ? 

Vascular  disturbances  of  the  pulp,  attended  by 
pain.     (See  Hyperemia  of  the  Pulp.) 

21.  What  in  exposed  pulps? 
Inflammation,  first  simple,  next  purulent,  affect- 
ing the  pulp. 

Hyperemia    of    the    Pulp — Grades    of    and 
Effects. 

1.  What  is  meant  by  hyperemia  of  the  pulp? 

An  excess  of  blood  in  the  dilated  vessels  of  the 
pulp. 

2.  What  is  its  cause? 

Exposure  of  the  pulp  to  sources  of  irritation, 
either  extrinsic,  through  the  invasion  of  caries, 
heating  in  finishing,  etc.,  or  intrinsic,  owing  to  the 
presence  of  calcific  deposits  upon  or  in  the  pulp. 

3.  What  is  its  morbid  anatomy  and  pathology? 
The  irritation  produces  a  paralysis  of  vessel-walls, 

and  the  vessels  are  irregularly  dilated  in  the  form  of 
minute  aneurisms.  If  the  irritation  be  continued, 
extravasations  of  blood  may  occur  from  the  dilated 
vessels.  Death  of  the  pulp  may  occur  from  hemor- 
rhagic infarction. 

4.  What  are  its  symptoms? 

Remarkable  increase  of  response  to  slight  ther- 
mal changes.  Pain  commonly  referred  to  some 
other  than  the  affected  tooth,  or  along  the  course  of 
the  fifth  nerve,  the  pain  being  frequently  referred  to 


76  COMPEND    OF 

the  ear.  Pain  is  paroxysmal,  sharp,  and  lancinat- 
ing. 

5.  What  is  its  diagnosis? 

The  symptoms  are  usually  elicited  in  a  carious 
tooth,  the  pulp  not  being  exposed.  Not  infre- 
quently it  occurs  in  teeth  not  the  seat  of  caries; 
diagnosis  is  made  by  isolating  each  suspected  tooth, 
and  testing  by  means  of  warm  and  cool  water;  the 
affected  tooth  gives  abnormal  response. 

6.  What  is  its  prognosis? 

Usually  depends  upon  the  number  and  severity  of 
the  paroxysms.  To  insure  continued  health,  the 
blood-vessels  must  resume  their  normal  condition. 
They  may  recover  their  tonicity  after  several  parox- 
ysms, and  yet  may  be  permanently  injured  by  one 
severe  paroxysm.  If  the  pulp  response  subsides  to 
the  normal,  recovery  has  occurred;  an  increasing 
response  to  heat  is  a  danger-signal. 

7.  What  is  its  treatment? 

Obtain  rest  from  thermal  changes.  If  a  carious 
cavity  exists,  use  sedatives  in  the  cavity  and  fill  tem- 
porarily with  gutta-percha  or  temporary  stopping. 
If  the  symptoms  occur  in  a  tooth  without  a  cavity, 
cover  it  with  a  gutta-percha  cap  for  a  period. 

8.  What  medicinal  remedies  are  employed? 
First,    sedatives    in    the    carious    cavity;    oil    of 

cloves;  solutions  of  thymol  in  glycerol;  cocain  and 
glycerol.  These  remedies  are  to  succeed  the  ster- 
ilization of  the  infected  dentine.  Coagulating  anti- 
septics and  sedatives  are  of  questionable  utility. 
Counter-irritation,    either    a    vesicant    applied    but 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.   'J'] 

once  or  a  rubefacient  employed  for  some  time,  at  a 
point  distant  from  the  affected  tooth. 

9.  If  the  symptoms  persist,  what  condition  is 
indicated? 

Venous  hyperemia  or  congestion  of  the  pulp, 
with  permanent  alterations  of  the  walls  of  the  ves- 
sels. A  condition  frequently  attended  by  the  for- 
mation of  nodular  deposits. 

10.  What  treatment  is  indicated? 

Relieving  the  paroxysms  by  means  of  obtundents, 
and  subsequently  devitalizing  the  pulp. 

Inflammation  of  the  Dental  Pulp. 

1.  What  is  inflammation  of  the  pulp? 

The  phenomena  described  under  the  head  of  in- 
flammation occurring  in  the  dental  pulp,  but,  being 
confined  in  unyielding  walls,  the  tissues  cannot 
swell. 

2.  What  are  its  causes? 

Injuries  of  greater  severity  than  productive  of 
hyperemia.  Commonly  the  organ  is  exposed  to  the 
fluids  of  the  mouth,  and  pathogenic  organisms  gain 
access  to  it.  Blows  upon  a  tooth  may  give  rise  to 
pulpitis.  Injuries  to  the  vessel-trunks  as  they  enter 
the  apical  foramen,  such  as  rapid  moving  of  teeth 
by  regulating  appliances,  too  severe  wedging,  or 
increasing  looseness  of  teeth,  subjecting  the  vessels 
to  compression  or  torsion,  are  all  causes  of  pulpitis ; 
pressure  of  fillings  upon  the  pulp  or  thin  laminae  of 
dentine  covering  it;  exposure  in  excavation  and  the 
employment  of  irritating  remedies  or  materials  are 


78  COMPEND    OF 

also     causes;     conductivit}^     of     thermal     chang-es 
through  metallic  fillings. 

3.  What  is  its  morbid  anatomy? 

The  veins  are  distended;  foci  of  cellular  exudates 
are  seen ;  these  latter  may  occur  at  but  one  point,  or 
be  generally  distributed  throughout  the  pulp.  Ex- 
travasations of  red  corpuscles  may  be  seen,  which 
appear  to  be  foci  of  inflammation.  Owing  to  the 
confinement  of  the  pulp,  fluid  exudates  cannot 
occur,  except  the  organ  be  largely  exposed,  when 
fluid  exudations  occur  (coagulable  lymph),  and  the 
pulp  swells  through  the  orifice  of  exposure.  In 
some  cases  the  pulp  undergoes  hypertrophic 
changes,  as  the  result  of  chronic  inflammation,  and 
extrudes  from  the  chamber,  in  some  cases  filling  a 
large  carious  cavity.  The  condition  is  known  as 
fungous  pulp. 

4.  What  are  its  symptoms? 

The  pain  is  more  continuous  than  in  hyperemia; 
it  is  dull  and  heavy;  increases  markedly  in  the  re- 
cumbent position.  In  other  cases  no  symptoms 
other  than  a  vague  uneasiness  may  exist,  and  yet 
marked  pulpitis  be  present.  Percussion  upon  the 
afifected  tooth  elicits  increased  response.  Pains 
may  be  indefinitely  localized  or  referred  entirely  to 
distant  parts,  notably  to  the  ear,  the  temporal  or 
occipital  region. 

5.  What  is  its  prognosis? 

Pulps  may  remain  vital  after  attacks  of  marked 
inflammation,  but,  as  a  rule,  those  whicli  have  been 
the  seat  of  pulpitis  are  debilitated  and  die. 

6.  What  is  its  treatment? 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.       79 

If  the  inflammation  has  not  been  violent,  it  is  a 
common  practice  to  attempt  the  conservation  of  the 
pulp,  which  attempt  is  rarely  successful.  The  den- 
tine and  surface  of  the  pulp  are  sterilized;  the  in- 
flammatory action  is  dispelled  by  means  of  seda- 
tives in  the  cavity  and  counter-irritants  applied  to 
the  gum. 

Pulp-Capping. 

1.  What  is  the  treatment  of  exposed  pulp? 
Provided  the  exposure  be  recent  and  no  vascular 

disturbances  have  been  evident,  indicated  by  throb- 
bing or  gnawing  pain,  an  attempt  is  made  toward 
its  conservation. 

2.  How  is  this  accomplished? 
Through  the  operation  of  pulp-capping. 

3.  What  is  the  object  in  saving  the  pulp? 

It  prevents  loss  of  translucency  of  the  tooth. 
Teeth  containing  vital  pulps  are  stronger  than  those 
from  which  this  organ  has  been  removed.  Teeth 
which  have  lost  their  pulps  may  become  the  seat  of 
pericementitis,  an  affection  very  rare  in  those  con- 
taining vital  pulps. 

4.  What  are  the  conditions  for  success  in  this 
operation? 

The  pulp  itself,  when  sources  of  irritation  are  re- 
moved, must  be  in  such  condition  that  a  return  to 
its  normal  state  is  possible.  Considering  the  ana- 
tomical changes  in  the  vessels  of  the  pulp,  which 
accompany  hyperemia,  it  is  rare  that  a  pulp  may  be 
saved  which  has  been  the  seat  of  more  than  one  con- 
tinued attack  of  throbbing  pain.     An  exposed  pulp 


8o  COMPEND    OF 

is  almost  immediately  invaded  by  pyogenic  organ- 
isms, so  that  pulps  which  have  been  exposed  may 
be  invaded  by  the  suppurative  process  and  give  but 
little  subjective  evidence  of  disease.  The  symp- 
toms elicited  by  the  operator,  although  a  guide,  are 
by  no  means  an  absolute  one.  The  patient's  physi- 
cal condition  and  temperament  must  be  such  as 
will  favor  the  recuperative  process. 

5.  How  is  the  exposure  of  the  pulp  diagnosed? 
Exposure  of  the  pulp  may  not  be  evident;  it  is  not 

always  to  be  detected  by  sight.  The  existence  of 
dentine  fissures  or  malformations  may  subject  the 
organ  to  the  ingress  of  irritants,  and  there  be  no 
external  evidence  of  exposure.  A  point  of  exposure 
is  usually  seen  as  a  round,  red  area. 

6.  What  is  the  prognosis  of  the  operation? 

In  a  majority  of  cases,  bad,  the  pulp  either  exhib- 
iting immediate  evidence  of  vascular  disturbance, 
or  its  painless  death  ensues.  The  ratio  of  success 
is  greatest  with  freshly-exposed  pulps,  particularly 
with  those  which  have  been  accidentally  exposed  by 
the  operator  in  excavating. 

7.  What  qualities  should  a  proper  pulp-capping 
possess? 

It  must  be  non-irritating,  unchangeable  in  bulk 
or  form,  and  be  applied  without  the  exercise  of  the 
slightest  pressure.  If  it  is  antiseptic  and  sedative, 
it  is  all  the  better. 

8.  What  materials  are  in  common  use  for  the 
purpose? 

A  paste   of  zinc   oxid  and  oil   of  cinnamon   or 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.   8 1 

cloves;  a  paste  of  zinc  oxysulfate,  which  hardens; 
layers  of  paper  coveredi  with  ethereal  varnishes; 
small  disks  of  softened  gutta-percha  are  also  em- 
ployed. Oxychlorid  of  zinc  is  an  unreliable  mate- 
rial in  this  connection.  It  may  produce  any  grade 
of  irritation  when  applied  as  a  capping. 

9.  How  is  the  zinc  paste  applied? 

The  tooth  is  placed  under  rubber-dam.  The  cav- 
ity and  surface  of  the  pulp  are  thoroughly  sterilized 
by  means  of  a  3  per  cent,  solution  of  pyrozone,  or  a 
10  per  cent,  solution  of  meditrina,  then  dried.  A 
concave  disk  of  tin  or  lead,  about  twice  as  large  as 
the  area  of  exposure,  is  filled  with  the  paste  mixed 
thin.  This  is  carried  into  position  and  placed  very 
gently.  The  patient  should  feel  no  pain.  The  sur- 
plus paste  is  wiped  from  about  the  edges  of  the  cap, 
and  a  film  of  ethereal  varnish  quickly  applied,  while 
the  cap  is  held  in  position  by  an  instrument ;  as  soon 
as  the  varnish  hardens,  holding  the  cap  in  position, 
a  thin  paste  of  zinc  phosphate  is  flowed  over  the 
cap,  covering  it  and  the  deeper  portion  of  the 
cavity,  and  lining  the  latter  completely. 

10.  How  is  the  oxysulfate  applied? 

A  saturated  solution  of  zinc  sulfate  in  water  is  the 
fluid  of  this  cement,  the  powder  being  uncalcined 
zinc  oxid.  From  powder  and  fluid  a  thin  paste  is 
made.  A  small  piece  of  glazed  paper,  large  enough 
to  fully  cover  the  area  of  exposure,  is  dipped  in  the 
paste,  and  quickly  and  gently  laid  over  the  ex- 
posure, where  it  quickly  hardens.  This  is  covered 
in  turn  by  a  layer  of  zinc  phosphate. 


o2  COMPEND    OF 

11.  What  are  the  indications  of  success  follow- 
ing this  operation? 

A  slight  discomfort,  which  gradually  grows  less, 
until  the  pulp  merely  exhibits  a  normal  reaction  to 
applications  of  heat  or  cold.     (Flagg.) 

12.  What  are  the  signs  of  failure? 

An  increasing  response  to  applications  of  heat  or 
cold,  particularly  of  the  former.     (Flagg.) 

Dr.  Flagg  counts  from  six  to  twelve  months  as 
the  period  of  probation. 

13.  What  other  disposition  may  be  made  of  ex- 
posed pulps? 

They  may  be  devitalized,  removed,  and  the  space 
formerly  occupied  by  them  filled  with  a  material 
v/hich  shall  hermetically  seal  the  root  at  its  apex. 

Extirpation  of  the  Pulp. 

1.  What  are  the  two  methods  in  vogue  of  pre- 
paring the  dental  pulp  for  extirpation? 

Benumbing  it  by  injections  of  cocain,  and  devital- 
izing it  by  means  of  preparations  containing  arsenic 
trioxid.  Cocain-guaiacol  may  be  driven  into  the 
pulp  by  a  cataphoretic  current,  destroying  the  sen- 
sibility of  the  organ.  Applications  of  the  arsenic 
trioxid  are  in  almost  universal  use. 

2.  What  is  the  action  of  arsenic  upon  the  vital 
pulp? 

Its  application  is  followed  by  pain,  which  may  be 
continuous  or  throbl^ing,  usually  lasting  for  about 
two  hours.  It  is  evident  that  hyperemia  and  inflam- 
mation are  refiexly  induced  by  the  irritation  of  the 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       83 

sensory  filaments.  When  the  pam  ceases,  indicat- 
ing paralysis  of  the  nerves,  the  arsenic  is  absorbed 
by  the  pulp  and  its  vitality  destroyed.  There  is  no 
absorption  during  the  inflammatory  stage,  and  no 
absorption  should  the  pulp  be  the  seat  of  inflam- 
mation when  the  arsenical  application  is  made. 

3.  What  amount  of  arsenic  is  usually  applied? 
From  the  i-ioo  to  1-25  part  of  a  grain. 

4.  How  does  variation  of  the  dose  influence  the 
effect? 

Very  minute  quantities,  as  a  rule,  cause  delay  in 
the  death  of  the  pulp.  Applications  of  larger  doses 
may  be  followed  by  symptoms  of  apical  pericemen- 
titis. 

5.  What  agencies  influence  the  results  of  appli- 
cation? 

First,  the  menstruum  employed.  Carbolic  acid, 
by  its  coagulating  effect,  interferes  with  the  absorp- 
tion of  the  arsenic.  Pulps  in  a  state  of  inflammation 
will  not  absorb  the  arsenic.  The  presence  of  de- 
posits of  secondary  dentine  in  the  pulp  may  render 
the  effects  of  an  arsenical  application  almost  nil. 

6.  What  is  the  length  of  time  usually  required 
to  effect  pulp-devitalization? 

From  twenty-four  to  forty-eight  hours. 

7.  What  is  the  usual  source  of  great  and  contin- 
ued pain  following  an  application  of  arsenic? 

Pressure  of  the  application  and  its  covering  upon 
the  pulp. 

8.  What  is  the  usual  formula  of  arsenical  paste? 


84  COMPEND    OF 

R — Arsenious  acid,  gr.  j ; 

Cocain  hydrochlor.,  gr.  ij; 
Ol.  cinnamon,  q.s.     Ft.  paste. 

9.  What  are  the  offices  of  these  constituents? 

The  ol.  cinnamon  is  a  sedative  and  non-coagulat- 
ing antiseptic.  The  cocain  is  analgesic,  and  causes 
the  contraction  of  the  arterioles,  lessening  the  hy- 
peremia, thus  facilitating  the  absorption  of  the  ar- 
senic, the  devitalizing  agent. 

10.  What  is  the  first  step  preparatory  to  making 
an  arsenical  application? 

Washing  the  cavity  with  strong  antiseptics,  re- 
moving debris,  and,  where  perfectly  feasible,  gain- 
ing full  access  to  the  pulp.  Should  any  inflamma- 
tion be  present,  the  cavity  is  washed  out  with  warm 
electrozone,  and  an  application  of  thymol  and  ol. 
cinnamon  made  until  the  symptoms  have  disap- 
peared. This  is  sealed  in  the  cavity  for  twenty-four 
hours,  when  the  arsenical  application  may  be  made. 

11.  What  two  important  precautions  are  to  be 
taken? 

First,  that  no  arsenic  come  in  contact  with  the 
gum,  or  sloughing,  which  may  be  extensive,  will 
certainly  occur;  second,  the  avoidance  of  all  pres- 
sure upon  the  pulp. 

12.  How  are  these  accidents  guarded  against? 
First,  by  so  shaping  the  cavity  as  to  form  a  deep 

pocket  for  the  reception  of  the  application,  and  em- 
ploying a  material  for  its  retention  which  may  pre- 
vent its  escape  upon  the  gums;  to  avoid  pressure, 
the  retaining  medium  should  be  a  material  which 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       85 

mav  be  placed  Avithont  the  exercise  of  pressure  and 
which  shall  hermetically  seal  the  cavity.  Zinc  phos- 
phate is  the  material  recommended  for  this  purpose. 

13.  How  is  the  application  to  be  made? 

A  disk  of  paper  or  a  small  ball  of  cotton,  about 
I- 16  inch  in  diameter,  is  to  have  placed  upon  it  a 
portion  of  the  paste  about  the  size  of  a  pin-head. 
This  is  laid  gently  upon  the  point  of  exposure,  and 
zinc  phosphate,  mixed  thin,  is  flowed  over  it  to  re- 
tain it  in  position.  Before  the  cement  has  set,  the 
saliva  is  admitted  to  its  surface.  In  about  forty- 
eight  hours  the  cement  and  paste  are  removed,  and 
the  pulp  will  be  found  devitalized. 

14.  What  result  occasionally  follows  an  arsenical 
application,  and  what  is  its  treatment? 

Intense  pain  upon  contact  of  the  arsenic  with  the 
pulp.  The  application  is  to  be  removed;  sedatives 
applied;  when  quiet  is  restored,  the  arsenic  is  placed 
at  some  distance  from  the  pulp,  sealed  in,  and  per- 
mitted to  remain  for  a  week. 

15.  How  are  devitalized  pulps  removed? 

By  means  of  barbed  extractors,  and  in  some  in- 
stances by  chemical  solvents. 

16.  What  other  disposition  may  be  made  of  the 
devitalized  pulp? 

The  coronal  portion  may  be  removed,  and  the 
canal  portions  converted  into  stiff  antiseptic  fila- 
ments. 

17.  How  is  this  accomplished? 

By  means  of  mummifying  pastes.  Prepkrations 
which  contain  alum  or  tannin  as  a  hardening,  gly- 


86  COMPEND    OF 

cerol  as  a  dehydrating,  and  thymol  as  an  antiseptic 
agent. 

i8.     When  is  this  method  employed? 

When,  for  any  reason,  it  is  impracticable  or  im- 
possible to  thoroughly  remove  pulp-iilaments  and 
fill  the  canals. 

19.  What  is  a  primary  essential  to  the  removal 
of  pulp-filaments? 

Familiarity  with  the  anatomy  of  pulp-chambers 
and  canals. 

20.  What  is  the  usual  form  of  the  dental  pulp? 
It  represents  an   approximate   miniature   of  the 

tooth. 

21.  What  is  the  usual  arrangement  of  pulp- 
canals  in  the  several  teeth? 

The  central  and  lateral  incisors  and  cuspids 
(upper)  exhibit  an  almost  round  orifice  of  en- 
trance to  the  pulp-canals.  The  upper  first  bi- 
cuspid, commonly  two  canals,  a  round  opening  into 
the  buccal  and  one  into  the  palatal  aspect  of  a  root, 
frequently  bifurcated  for  half  its  length.  These 
openings  may  be  connected  by  a  fine  line.  The 
upper  second  bicuspid  usually  has  a  dumb-bell- 
shaped  canal  orifice.  The  upper  molars,  three 
canals,  as  a  rule;  the  palatal  canal  has  a  large  round 
orifice;  that  of  the  anterior  buccal  root,  round  or 
triangular  and  small;  the  disto-buccal  root,  very 
small.  The  same  arrangement  is  found  in  the  sec- 
ond molar;  in  the  third  molar,  also;  but  here  varia- 
tions are  not  uncommon.  There  may  be  but  one 
large   canal,   and,   again,   four,   or  it   may  be   five 


DENTAL    PATHOLOGY    AND    THERAPEUTICS,       87 

minute  ones.  The  lower  incisors,  cuspids,  and  bi- 
cuspids usually  have  a  single  canal,  which  has  an 
oval  opening'.  The  lower  molars  have,  as  a  rule,  but 
two  roots.  The  canal  of  the  posterior  root  is  large, 
and  has  a  round  orifice.  Those  of  the  anterior  roots 
are  small,  and  have  a  dumb-bell  shape;  the  handle 
long  and  attenuated.  The  roots  of  the  several  teeth, 
when  curved,  usually  have  the  apices  of  the  roots 
pointing  from  the  median  line.  There  are,  how- 
ever, numerous  exceptions  to  this  rule. 

22.  How  is  a  pulp  removed? 

The  tooth  is  sterilized,  placed  under  rubber-dam, 
and  washed  out  with  pyrozone.  Free  entrance  is 
gained  to  the  pulp-chamber,  and  the  body  of  the 
pulp  is  burred  away  or  cut  away.  Easy  entrance 
is  next  obtained  to  each  pulp-canal.  A  tested 
barbed  extractor,  placed  in  a  light  handle,  is  passed 
up  the  largest  canal,  if  a  multi-rooted  tooth,  the 
barbs  being  turned  away  from  the  pulp  until  it  is  as 
far  as  it  can  readily  be  passed,  when  the  broach  is 
rotated,  the  teeth  engaging  the  length  of  the  pulp- 
filament,  and  it  is  withdrawn;  the  operation  is  re- 
peated in  the  other  canals. 

23.  Should  any  filaments  remain,  what  disposi- 
tion is  to  be  made  of  them? 

Sulfuric  acid,  50  per  cent,  sol.,  or  trichloracetic 
acid,  full  strength,  is  pumped  into  the  canal  by 
means  of  fine  cleansers  until  the  filaments  are  de- 
stroyed. 

24.  What  condition  is  now  found  at  the  apex? 
A  lacerated  wound,  if  vital  connection  between 


65  COMPEND    OF 

pulp  and  pericementum  existed,  indicated  by  pain 
in  removing  the  pulp;  a  cicatrized  wound,  if  the 
connection  has  been  destroyed  completely.  That 
is,  if  the  arsenic  has  been  in  for  more  than  three  or 
four  days. 

25.  What  is  the  usual  practice  followed  after 
complete  non-septic  extirpation  of  the  pulp? 

Immediate  root-filling.  The  canals  are  washed 
out  with  pyrozone  to  remove  blood  and  to  assure 
sterilization.  Alcohol  is  pumped  into  the  canal  by 
means  of  broaches,  and  is  evaporated  until  the  den- 
tine appears  dry.  The  majority  of  clinicians  next 
pump  a  small  quantity  of  oil  of  eucalyptus  in  each 
canal,  and  fill  the  canals  with  preferabl}'  gutta- 
percha points  packed  with  warmed  instruments. 
Statistics  indicate  that  the  greatest  ratio  of  success 
attends  the  filling  of  the  canals  with  a  paste  of  oxy- 
chlorid  of  zinc. 

26.  What  olDJection  is  urged  against  immediate 
root-filling  with  gutta-percha  or  oxychlorid? 

Difficulty  in  removing  these  fillings  in  case  trau- 
matic pericementitis  should  occur,  which  is  not  un- 
common. 

27.  What  practice  is  advised  in  its  stead? 

The  filling  of  the  canal  for  a  week  with  aristol 
and  well-packed  crude  cotton,  when  the  wound  at 
the  apex  will  have  healed. 

Suppuration  of  the  Pulp. 

I.     What  is  meant  by  suppuration  of  the  pulp? 
The  formation  of  pus  upon  the  surface  or  within 


DENTAL    PATHOLOGY"    AND    THERAPEUTICS.       89 

the  substance  of  the  dental  pulp.  In  the  former 
case  it  is  ulceration  of  the  pulp;  in  the  latter,  ab- 
scess. 

2.  What  are  its  causes? 

The  invasion  of  the  pulp  by  pyogenic  organisms. 
In  a  majority  of  cases  the  pulp  is  exposed  to  the 
fluids  of  the  m.outh;  the  organisms  gaining  access  to 
the  surface  of  the  pulp,  a  molecular  disintegration  of 
that  organ  proceeds;  it  is  destroyed  progressively 
bv  an  ulcerative  action.  The  process  not  infre- 
quently follows  upon  attempts  at  the  saving  of  pulps 
which  have  been  exposed.  Cases  of  increased  con- 
ductivity through  metallic  fillings  may  run  the  scale 
of  hyperemia,  inflammation,  then  suppuration. 

3.  What  is  the  pathology  and  morbid  anatomy 
of  suppuration  of  the  pulp? 

There  are  two  classes  of  cases,  the  ulcerative  and 
the  abscess.  The  former  may  also  be  subdivided 
into  two  classes:  First,  those  in  unfilled  teeth;  sec- 
ond, those  occurring  in  teeth  which  have  been  filled. 
In  the  first  class,  occurring  after  pulp-exposure,  the 
carious  cavities  being  unfilled,  the  blood-vessels 
are  irregularly  dilated;  there  is  an  irregular  loss  of 
tissue  from  the  surface  of  the  pulp;  beyond  the  sup- 
purating surface  the  vessels  are  surrounded  by  a 
profuse  inflammatory  exudation  (cellular) ;  the  ul- 
cerative process  undermines  the  layer  of  odonto- 
blasts, which  retain  their  forms  longer  than  the  other 
tissue-cells  of  the  pulp;  the  ulceration  may  involve 
the  organ  to  any  extent.  Second,  cases  occurring 
under  fillings;   immediately  upon  the  removal   of 

13 


QO  COM PEN D    OF 

the  filling  and  pulp-capping,  pus  is  seen  to  escape 
from  the  surface  of  the  pulp.  Examination  of  such 
pulps  may  exhibit  the  effects  of  ulceration  or  those 
of  class  two,  or  abscess  of  the  pulp.  This  process 
may  occur  without  the  destruction  of  the  layer  of 
odontoblasts  covering  the  pulp,  for  upon  puncturing 
the  pulp,  an  escape  of  pus  follows.  An  examination 
reveals  one  or  several  abscess-cavities,  some  filled, 
others  unfilled  with  pus.  There  may  be  one  large 
cavity  occupying  the  center  of  the  pulp.  The  pro- 
cess of  suppuration  follows  the  veins.  In  some 
cases  the  abscess  may  involve  the  entire  organ,  giv- 
ing it  a  white  appearance. 

4.  What  are  the  symptoms? 

Those  of  inflammation  of  the  pulp,  but  intensi- 
fied. There  is  a  greater  exhibition  of  reflex  pains. 
Perhaps  the  most  constant  symptom  is  increased 
response  to  hot  applications,  which  subsequent  cold 
applications  relieve.  In  the  last  stages,  symptoms 
of  pericementitis  supervene,  which  usually  csase  for 
a  variable  period  after  sloughing  of  the  pulp. 

5.  What  is  the  prognosis? 

Fatal  to  the  pulp.  If  the  pulp-canals  be  not  per- 
fectly cleansed  and  sterilized,  pericementitis  and  al- 
veolar abscess  may  occur  in  from  a  week  to  years. 

6.  What  is  the  treatment? 

In  the  last  stages,  the  remnants  of  the  pulp,  as 
a  rule,  may  be  removed  painlessly  by  means  of  a 
barl^ed  broach.  In  the  earlier  stages,  the  insensitive 
portions  of  the  pulp-tissue  are  scraped  away.  If  the 
suppurative  process  be  very  superficial,  an  applica- 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       9I 

tioii  of  arsenic  is  made.  As  soon  as  the  pulp-cham- 
ber is  opened  it  is  to  be  filled  with  powerful  antisep- 
tics, such  as  25  per  cent,  pyrozone,  or  a  25  per  cent. 
sol.  of  sodium  peroxid.  If  the  root  portions  of  the 
pulp  be  still  sensitive,  progressive  broaching  with  a 
50  per  cent.  sol.  sulfuric  acid  will  usually  enable  the 
operator  to  destroy  and  remove  them.  Ten  per 
cent.  sol.  of  formalin  may  be  applied  and  sealed  in 
the  tooth  for  a  week.  This  penetrating  antiseptic 
devitalizes  and  hardens  the  remaining  tissue,  and  it 
may  then  be  removed.  Subsequent  to  the  removal 
of  the  pulp,  the  pulp-canals  and  dentine  must  be 
rendered  aseptic. 

7.  How  is  this  accomplished? 

As  a  rule,  by  applications  of  50  per  cent.  sol.  of 
sodium  peroxid.  The  solution  NaoOs  is  pumped 
into  the  canals  and  perm.itted  to  remain  for  a  few 
minutes,  when  an  application  of  hydrochloric  acid 
(10  per  cent,  sol.)  is  made.  Sodium  hydrate  and 
sodium  chlorid  are  formed,  and  nascent  oxygen  dis- 
engaged. (Na/J.-f  HCl  =  NaOH+NaCl+O.) 
The  sodium  hydroxid  saponifies  the  fatty  matters, 
dissolves  albuminous  matters;  the  disengaged  oxy- 
gen acts  as  a  sterilizer,  and,  being  liberated  in  deep 
parts,  drives  out  the  solutions. 

8.  What  is  the  usual  practice  in  such  cases? 
Immediate  root-filling  as  soon  as  sterilization  is 

assured. 

9.  What  material  as  a  root-filling  has  met  with 
the  greatest  measure  of  success,  according  to  sta- 
tistics? 


92  COMPEND    OF 

Zinc  oxychlorid;  although  many  or  most  op- 
erators prefer  gutta-percha. 

Diseases  of  the  Periceaientum. 

1.  What  are  the  morbid  conditions  to  which  the 
pericementum  is  subject? 

A  series  of  nutritive  disturbances,  ranging  from 
sHght  and  continued  hyperemia  to  molecular  necro- 
sis of  its  entire  substance. 

2.  What  is  meant  by  pericementitis? 

An  inflammation  of  the  meml^rane  covering  the 
roots  of  teeth.  It  is  also  called  dental  periostitis  and 
periodontitis. 

3.  Into  what  classes  may  these  inflammations  be 
divided? 

Into  three:  first,  those  beginning  at  the  gum  mar- 
gin; second,  those  beginning  at  the  apex  of  the 
root;  third,  those  beginning  at  some  lateral  aspect. 

4.  What  are  the  causes  of  the  first  variety? 
First,   salivary   calculi;   second,   serumal   calculi; 

third,  the  local  effects  of  drugs  being  eliminated  at 
the  gum  margin,  notably  mercury,  i:)Otassium  iodid, 
and  pilocarpin. 

5.  What  is  the  usual  cause  of  the  second  variety? 

The  entrance  of  septic  matter  from  the  pulp- 
canals  of  pulpless  teeth  to  the  tissues  of  the  apical 
space. 

6.  What  are  the  causes  of  the  third  class,  those 
producing  phagedenic  pericementitis? 

Gouty  pericementitis  and  inflanuuations  follow- 
ing plantation. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       93 

7.  How  is  pericementitis  classified  as  to  dura- 
tion of  existence? 

Into  acute  and  chronic. 

8.  What  is  its  range  of  severity? 

That  of  any  periostitis;  it  may  range  from  a  mild 
stimulation,  leading  to  a  localized  thickening  of  the 
cementum,  to  a  general  periostitis,  involving  the 
bodies  of  the  maxillary  bones. 

9.  What  is  the  general  symptom  of  the  mild 
cases? 

Slight  hypersensitivity  upon  percussion. 

10.  What  of  severe  cases? 

General  inflammatory  symptoms  about  the  parts ; 
fever,  with  all  of  its  attendant  symptoms;  the  tem- 
perature, in  extreme  cases,  may  rise  to  105°  F. 
Subsequently,  septicemia,  or  even  pyemia  and 
death,  may  occur. 

11.  What  is  the  common  cause  of  the  severe 
cases? 

Entrance  of  pyogenic  organisms  from  the  pulp- 
canals  of  teeth  into  the  tissues  of  the  apical  space 
and  into  the  lymphatics. 

12.  How  may  pericementitis  be  classified  ac- 
cording to  its  effects? 

Into  constructive  and  destructive. 

13.  What  are  meant  by  these? 
Constructive  pericementitis  is  the  form  causing 

hypertrophy  of  the  cementum.  A  destructive  peri- 
cementitis is  one  causing  a  degeneration  and  necro- 
sis of  the  pericementum. 

14.  What  is  hypercementosis? 


94  COMPEND    OF 

A  localized  or  general  hypertrophy  of  the  ccmen- 
tnm  of  a  tooth. 

15.  What  is  its  cause  (general)? 

A  slight  and  continued  irritation  of  the  perice- 
mentum,— a  constructive  pericementitis. 

16.  Specify  some  of  its  particular  causes. 

Faulty  occlusion,  thread-biting,  biting  hard  sub- 
stances, are  causes  affecting  the  apical  and  lateral 
aspects  of  the  teeth.  Other  sources  of  irritation 
may  be  found  in  irritation  of  the  gingival  portion  of 
the  pericementum,  by  invasion  of  caries;  protrud- 
ing fillings  irritating  the  soft  tissues;  perforated 
roots,  or  the  presence  of  foreign  bodies  at  the  edge 
of  the  pericementum;  beyond  the  inflammatory 
focus,  about  the  source  of  irritation,  the  pericemen- 
tum may  be  stimulated  to  constructive  activity. 
Cases  are  found  for  which  there  is  no  discoverable 
cause. 

17.  What  is  the  morbid  anatomy  of  hyper- 
ccmentosis? 

The  pericementum  is  slightly  liyperemic.  Pro- 
jecting from  the  general  surface  of  the  cementum 
are  secondary  masses.  These  may  be  isolated  nod- 
ules; bulbous  masses  about  the  apices  of  the  teeth; 
or,  again,  the  thickening  may  be  general,  a  distinct 
line  marking  near  the  neck  of  the  tooth  the  junction 
of  the  secondary  with  the  original  cementum.  Sec- 
tions exhibit  the  union  of  the  growth  with  its  base. 
The  deposits  have  the  appearance  of  exostosis. 
They  may  be  soft  or  hard,  and  in  some  cases  re- 
markably smooth. 


DENTAL   PATHOLOGY   AND    THERAPEUTICS.       95 

18.  What  are  its  symptoms? 

Those  of  a  very  mild  pericementitis,  occurring 
in  a  tooth  at  irregular  intervals;  as  the  deposit 
increases,  painful  sensations  become  more  severe, 
until  the  tooth  becomes  the  seat  of  intractable  pain. 
These  symptoms  may  extend  over  a  period  of  years. 
Its  occurrence  is  unusual  before  the  age  of  thirty- 
five. 

19.  What  are  the  more  remote  effects  of  hyper- 
cementosis? 

Dr.  Flagg  {Dental  Cosmos,  March,  1878)  presents 
a  list  of  reflex  nervous  disturbances,  involving  not 
only  the  several  branches  of  the  fifth  cranial  nerve, 
but  the  second,  eighth  (sight  and  hearing),  and  also 
some  of  the  cervical  nerves,  all  of  which  he  has 
found  associated  with  dental  exostosis. 

20.  What  is  its  diagnosis? 

It  is  made  by  exclusion,  the  patient  usually  com- 
plaining of  pain  about  the  teeth:  each  probable 
source  of  pain  is  sotrght  out,  until,  if  no  other  ex- 
planation be  found,  exostosis  is  suspected.  Many 
of  the  diagnoses  of  the  cases  giving  rise  to  wide 
reflex  pain  are  post-mortem,  extraction  revealing 
the  presence  of  hypertrophied  cementum.  In  ob- 
stinate ocular  or  aural  disorders,  for  which  the  aid 
of  specialists  has  been  unavailing,  an  examination 
of  the  teeth  may  reveal  a  dental  disorder  as  the 
possible  source  of  the  reflex  pain. 

21.  What  is  the  prognosis  of  hypercementosis? 
Many  cases  of  hypercementosis  give  rise  to  no 

symptoms;  those  which  are  the  source  of  pain  fur- 


96  COMPEND    OF 

nish  a  bad  prognosis  as  to  the  preservation  of  the 
tooth. 

22.  What  is  its  treatment? 

In  its  earher  stages,  when  mere  passing  discom- 
fort is  the  complaint,  local  massage  may  be  em- 
ployed. Any  evident  sources  of  irritation,  such  as 
malocclusion,  caries  invading  the  cementum,  or 
foreign  bodies,  are  to  be  corrected,  remedied,  or  re- 
moved. In  persistent  cases  extraction  is  the  only 
remedy;  the  extraction  must  be  carefully  and  com- 
pletely made.  In  event  of  a  reflex  neuralgia  being 
ascribed  to  the  hypercementosis,  extraction  is  to  be 
guarded.  As  it  is  next  to  impossible  to  positively 
locate  the  affected  tooth,  •  the  most  probable  of- 
fender is  removed  first  and  the  effect  noted;  more 
than  one  extraction  may  be  required. 

23.  What  is  meant  by  traumatic  pericementitis? 
Pericementitis  arising  as  the  result  of  mechan- 
ical violence. 

24.  What  is  its  common  cause? 

Blows,  falls,  thread-biting,  excessive  use  of  the 
mallet  in  building  down  teeth;  severe  wedging,  and 
too  severe  occlusion. 

25.  WHiat  are  its  grades  of  severity? 

It  ranges  from  a  mild  and  temporary  irritation  to 
abscess,  or  even  necrosis. 

26.  What  is  a  frequent  accompaniment  in  se- 
vere cases? 

Death  of  the  puli);  probably  due  to  thrombosis  of 
the  apical  vessels. 

2"].     What  are  its  symptoms? 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.       9/ 

In  mild  cases,  tenderness  upon  percussion ;  if 
more  severe,  slig^ht  protrusion  of  the  tooth  and 
greater  tenderness;  in  very  severe  cases  the  tooth 
may  be  forcibly  displaced. 

28.     What  is  the  morbid  anatomy? 

The  case  is  surgically  one  of  bruise.  If  a  very 
severe  blow  has  been  received  upon  the  tooth,  suf- 
fusion of  the  dentine  may  occur;  the  red  blood-cor- 
puscles are  disorganized,  and  their  coloring-matter 
invades  the  dentine.  If  the  pulp  has  been  killed, 
the  fact  may  not  become  evident  for  years,  and  only 
then  through  an  increasing  opacity  of  the  tooth. 

20.     A'NHiat  is  the  treatment? 

That  of  a  bruise;  surgical  rest  being  indicated, 
the  affected  tooth  is  to  be  immovably  held  by  a  suit- 
able appliance.  Remove  all  existing  sources  of  ir- 
ritation, and  apply  antiphlogistics.  such  as  frequent 
washing  with  ext.  hamamelis. 

30.  AA^hat  is  the  most  common  cause  of  acute 
pericementitis? 

The  entrance  of  micro-organisms  and  their  prod- 
ucts into  the  tissues  of  the  apical  spaces,  following 
upon  the  putrefactive  decomposition  of  the  dental 
pulp. 

31.  AYhat  are  the  symptoms  and  clinical  his- 
tory of  acute  apical  pericementitis? 

In  the  last  stages  of  purulent  pulpitis  a  tooth  re- 
sponds to  hot  applications,  the  pain  being  relieved 
by  cold.  The  tooth  exhibits  a  slight  sensitiveness 
to  pressure  and  percussion.  A  period  of  quiet  su- 
pervenes, of  some  weeks  or  months,  when  the  in- 
•4 


98  COAIPEND    OF 

duction  of  pain  upon  pressure  reappears.  The  gum 
overlying  the  tooth  becomes  injected.  The  effu- 
sion into  the  pericementum  causes  extrusion  of  the 
tooth,  so  that  it  is  longer  than  its  neighbors.  The 
pain  becomes  throbbing,  increasing  in  severity.  In 
mild  cases  the  symptoms  are  not  severe;  in  the  sec- 
ond grade  the  inflammatory  phenomena  are  more 
pronounced,  and  so  on  until  the  fifth,  the  most  se- 
vere grade,  when  the  contiguous  tissues  participate, 
and  there  is  great  oedema,  symptoms  of  more  or  less 
diffused  periostitis  of  the  maxillary  bone.  There 
may  be  rigors  (chills)  and  fever,  the  temperature  in 
some  instances  as  high  as  104°.  The  pulse,  full  and 
bounding  in  the  early  stages,  may  become  quick 
and  soft,  and  evidences  of  septic  intoxication  occur. 
Cases  are  recorded  where  the  disorder  unchecked 
has  been  followed  by  metastatic  abscesses  (pyemia) 
and  death. 

32.  What  is  its  diagnosis? 

A  tooth  containing  a  very  deep  cavity,  or  a 
crownless  root,  becomes  sore  to  pressure,  and  ex- 
truded from  its  socket;  the  gum  overlying  shows 
evidences  of  any  degree  of  inflammation.  Increas- 
ing tenderness  to  pressure,  and  general  inflamma- 
tory symptoms. 

33.  What  is  the  prognosis? 

Usually  depends  upon  the  readiness  and  com- 
pleteness with  which  the  exciting  causes  may  be  re- 
moved; second,  upon  the  severity  of  the  inflamma- 
tory symptoms.  If  the  conditions  are  favorable, 
the  comfortable  retention  of  the  tooth  for  years  is 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.        99 

probable.  If  symptoms  of  maxillary  periostitis  are 
pronounced,  the  affected  tooth  is  usually  doomed. 
In  more  severe  cases  adjoining  teeth  may  be  affected 
and  lost.  If  septic  intoxication  occur,  the  retention 
of  the  tooth  will  depend  upon  the  readiness  with 
which  the  symptoms  disappear  after  sterilization  of 
the  center  of  infection. 

34.  What  is  its  treatment? 

First,  that  of  all  inflammatory  diseases — remove 
the  cause.  As  this  latter  is  the  septic  matter  (pyo- 
genic and  other  organisms)  contained  in  canals,  the 
mouth  is  first  freely  lavaged  with  powerful  antisep- 
tics, solutions  of  phenol  sodique,  3  per  cent,  pyro- 
zone,  or  20.  per  cent.  sol.  of  meditrina.  Entrance  to 
the  pulp-chamber  is  secured  through  the  filling,  or, 
if  the  inflammatory  action  be  high,  by  the  shortest 
and  most  direct  path  through  the  tooth  by  means  of 
a  spear-pointed  drill.  The  affected  tooth  is  to  re- 
ceive mechanical  support  during  this  operation. 
Powerful  antiseptics  are  worked  into  the  canals  by 
means  of  broaches,  and  the  vent-hole  left  open. 
Counter-irritation  is  induced  over  the  healthy  gum 
adjoining  the  inflamed  area. 

35.  What  is  the  treatment  of  more  severe  cases? 
Even    though    the    inflammatory    symptoms    be 

marked,  accompanied  by  fever,  a  full,  bounding 
pulse,  an  attempt  may  be  made  to  abort  the  inflam- 
mation. The  antiseptic  measures  are  vigorously 
applied,  local  blood-letting  is  employed,  a  couple 
of  leeches  applied  to  the  gum,  and  hot  water  held  in 
the  mouth  after  their  removal.     Dry  cups  are  ap- 


100  COMPEND    OF 

plied  to  the  neck.  Quinine  snlph.,  gr.  viii,  to  which 
morphia  snlph.  gr.  ^  has  been  added,  are  adminis- 
tered; the  patient  placed  in  bed  with  the  head  ele- 
vated. If  the  pulse  be  full  and  bounding,  ten  drops 
tr.  aconiti  rad.  are  placed  in  water  oz.  i,  and  a  tea- 
spoonful  of  the  mixture  administered  every  hour 
until  the  pulse  is  normal.  If  in  five  hours  the  in- 
flammatory symptoms  are  not  relieved,  the  patient 
is  to  have  the  feet  placed  in  hot  water,  to  be  well 
wrapped  in  blankets,  and  Dover's  powder,  gr.  x  in 
hot  lemonade,  administered  until  there  is  free  dia- 
phoresis. The  succeeding  morning  a  tablespoonful 
of  magnesise  sulph.  is  given  in  a  gobletful  of  water. 

36.     What  is  the  rationale  of  this  treatment? 

The  local  blood-letting  and  dry  cups  are  for  the 
purpose  of  unloading  the  blood-vessels  of  the  af- 
fected area.  The  quinine  and  morphia  are  given 
to  reduce  the  extent  of  corpuscular  exudation  and  to 
quiet  the  irritability  of  the  nervous  system.  The 
maximum  of  quinine  effect  is  in  five  hours,  so  that 
if  at  the  expiration  of  that  time  the  desired  effect  be 
not  gained,  the  quiet  of  the  nervous  system  is  ob- 
tained by  the  action  of  the  opium  in  the  Dover's 
powder.  Both  opium  and  ipecacuanha  act  as  dia- 
phoretics ;  by  increasing  the  volume  of  blood  in  the 
cutaneous  circulation,  blood  is  drawn  from  the  in- 
flamed area.  The  administration  of  the  Epsom 
salts  is  for  the  purpose  of  derivation  and  lessening  of 
the  general  volume  of  the  blood.  The  aconite,  by 
reducing  the  pulse,  lessens  the  vascular  phenomena 
in  the  inflamed  area.     The  continued  use  of  anti- 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     lOI 

septics  by  destroying-  the  bacteria  lessens  the  symp- 
toms. 

37.  If,  despite  all  measures,  severe  inflammatory 
symptoms  are  not  reduced,  what  is  to  be  done? 

Immediate  extraction  of  the  offending  tooth. 

38.  What  is  the  common  result  of  acute  perice- 
mentitis? 

The  formation  of  pus  in  the  tissues  of  the  apical 
space. 

39.  What  is  this  called? 
Alveolar  abscess. 

40.  What  are  the  symptoms? 

After  the  inflammatory  symptoms  of  pericemen- 
titis have  been  present  for  from  twenty-four  to  sev- 
enty-two hours,  there  is  a  marked  lessening  of  their 
severity;  the  swelling  of  the  gum,  which  has  been 
tense  and  hard,  becomes  soft  and  easily  pitted;  the 
summit  of  the  swelling  becomes  yellow,  bursts,  and 
there  is  a  discharge  of  pus.  (This  will  be  discussed 
later.) 

41.  Wliat  is  another  common  variety  of  apical 
pericementitis? 

The  chronic. 

42.  What  are  its  causes? 

A  persistent  source  of  irritation  of  less  severity 
than  necessary  for  the  production  of  acute  apical 
pericementitis.  Septic  infection  of  mild  grade,  in 
teeth  having  open  canals  through  which  effusions 
may  drain  from  partially  cleansed  and  imperfectly 
sterilized  canals,  protruding  root-fillings,  mal- 
occlusion from  any  cause. 


I02  COMPEND    OF 

43.  "What  are  its  symptoms? 

The  tooth  is  tender  to  pressure,  shghtly  loosened, 
and  elongated.  There  is  more  or  less  vascular  in- 
jection of  the  overlying  gum. 

44.  \Miat  is  its  treatment? 

Removal  of  the  causes.  Determine  by  means  of 
articulating  (carbon)  paper  the  points  of  excessive 
contact:  if  there  be  malocclusion,  grind  away  the 
portions  marked  by  the  paper  until  the  tooth  is  free 
of  contact  with  its  antagonist;  this  gives  rest. 
Should  the  tooth  contain  a  large  open  cavity,  it  is  to 
be  sterilized.  Each  root-canal  is  to  be  entered  and 
thoroughly  cleansed  by  means  of  broaches  and  anti- 
septics. Be  careful  that  no  decomposing  matter  is 
thrust  through  the  end  of  the  root.  If  the  tooth 
contain  a  dead,  but  not  disintegrated  pulp,  endeavor 
is  made  to  extract  it  en  ))iasse.  If  the  symptoms  are 
found  with  a  tooth  containing  a  large  filling,  free  in- 
gress to  the  roots  is  to  be  secured  for  their  cleansing 
and  sterilization.  If  the  pulp  has  died  after  the 
insertion  of  a  filling,  it  is  removed,  the  roots  steril- 
ized and  filled.  If  a  pulpless  tooth,  careful  search  is 
made  for  uncleansed  or  imperfectly  cleansed  canals; 
these,  when  found,  are  thoroughly  cleansed,  steril- 
ized, and  filled.  Minute  or  tortuous  canals  are 
cleansed  by  fine  Donaldson's  cleansers  and  sulfuric 
acid.  A  drop  of  50  per  cent,  acid  is  applied  to  the 
entrance  of  the  canal,  and  the  cleansing  instrument 
is  introduced  progressively  by  a  combination  of 
careful  rotary  and  pumping  movements.  Addi- 
tional applications  of  acid  are  made  until  the  canals 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     I03 

are  freely  open.     The  snlfiiric  acid  also  acts  as  a 
sterilizing  agent  in  this  procedure. 

45.  How  is  a  dead  pulp  in  an  apparently  sound 
tooth  diagnosed  as  a  cause  of  pericementitis? 

Fiy  an  increasing  opacity.  A  light,  preferably  that 
of  the  electric  mouth-mirror,  is  placed  behind  the 
tooth,  and  its  loss  of  translucency  determined. 
Without  marked  malocclusion  the  tooth  is  found  to 
be  loosened  and  the  overlying  gum  injected. 

46.  How  are  such  Cases  treated? 

By  the  exercise  of  the  utmost  antiseptic  precau- 
tions. The  mouth  and  the  teeth  are  to  be  perfectly 
sterilized,  every  instrument  employed  to  be  soaked 
in  powerful  antiseptics.  After  gaining  direct  access 
to  the  pulp-chamber,  the  stronger  antiseptics  are 
applied  to  the  decomposing  material.  The  contents 
of  the  chamber  are  syringed  and  drawn  away  until 
the  canal  is  cleansed.  Applications  of  strong  solu- 
tions of  sodium  peroxid  are  made,  which  dissolve 
the  pulp  remnants  and  sterilize  the  canal  and  the 
dentine.  The  canal  is  then  filled  tentatively.  Un- 
less the  greatest  care  and  rigid  antisepsis  be  fol- 
lowed in  these  cases,  intractable  inflammation  of  the 
pericementum  may  arise. 

47.  What  is  the  patholog}'  and  morbid  anatomy 
of  alveolar  abscess? 

The  pyogenic  organisms  are  present  in  the  pulp- 
canals  of  teeth  containing  putrescent  pulps.  Their 
waste  products  are  a  source  of  irritation  to  the  tis- 
sues of  the  apical  space.  These  tissues  become  a 
suitable  soil  for  the  development  of  the  organisms. 


I04  COMPEND    OF 

Pericementitis  occurs,  as  above  described,  and  pus 
is  formed.  If  the  pus  finds  egress  through  the 
canal  of  the  tooth,  the  acute  inflammatory  symp- 
toms subside,  and  the  formation  of  pus  continues, 
owing  to  the  presence  of  the  organisms ;  but  so  long 
as  the  canal  remains  open  there  are  no  acute  symp- 
toms. If  the  pus  be  unable  to  make  exit  through 
the  natural  channel,  it  may  find  exit  in  one  of  sev- 
eral paths.  The  most  direct  path  is  to  the  external 
alveolar  wall,  except  in  the  palatal  root  of  superior 
molars,  where  its  path  is  toward  the  palatal  process. 
In  the  former  case,  the  wall  of  the  alveolus  is  at- 
tacked and  perforated;  the  suppurative  process  in- 
volves next  the  cancellated  tissue  of  the  alveolar 
process;  next,  its  outer  plate.  Before  finding  exit, 
the  external  periosteum  is  attacked,  and  it  may  be 
raised  from  the  outer  wall  of  the  process,  and  pus 
accumulate  between  the  periosteum  and  the  bone. 
Usually  the  pus  penetrates  the  periosteum;  next, 
the  gum,  finding  exit  immediately  over  the  apex  of 
the  affected  root. 

48.  What  result  may  follow  the  stripping  of  the 
periosteum? 

Necrosis  of  the  uncovered  bone. 

49.  In  what  other  situations  may  the  pus  find 
exit? 

In  abscess  affecting  the  lower  teeth  the  pus  may 
penetrate  the  body  of  the  bone  itself  and  overlying 
tissues,  and  escape  externally  upon  the  face,  as,  for 
example,  under  the  chin,  in  abscess  from  lower 
incisors.     Under  the  lateral  aspect  of  the  maxilla, 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.     I05 

from  abscess  upon  posterior  teeth,  the  pus  may 
meet  a  plane  of  tissue  and  follow  the  course  of  that 
tissue.  A  case  has  been  recorded  of  pus  burrowing 
along  the  fibers  of  the  platysma  myoides,  opening 
upon  the  shoulder.  In  upper  teeth,  the'pus  from  an 
abscess  over  the  centrals  or  laterals  may  perforate 
the  floor  of  the  nasal  cavity;  from  bicuspids  and 
molars,  perforation  of  the  floor  of  the  maxillary 
sinus  may  occur.  Others  of  these  cases  may  have 
opening  upon  the  cheek.  Not  infrequently  pus  from 
the  apical  abscess  finds  exit  at  the  neck  of  the  tooth. 

50.  What  is  the  diagnosis  of  alveolar  abscess? 
Any   fistula   found   about   the   jaws   or   alveolar 

process  is  to  be  referred  primarily  to  the  teeth.  As 
a  rule,  a  fistula  overlies  an  abscessed  root.  Ab- 
scess is  diagnosed  in  any  tooth  which  has  been  the 
seat  of  an  acute  pericementitis  lasting  more  than 
forty-eight  hours.  A  soft  silver  probe  may  be  bent 
to  follow  the  direction  of  the  sinus,  and  thus  detect 
the  afTected  tooth.  This  procedure  should  be  fol- 
lowed with  all  fistulas  about  the  jaws  or  face. 

51.  What  is  the  diagnosis  of  alveolar  abscess 
without  fistulous  opening? 

As  a  rule,  the  pulp-chamber  will  be  found  com- 
municating with  the  exterior  through  a  large  cari- 
ous cavity.  The  pulp-chamber  and  canals  are  filled 
with  a  decomposing  mass;  the  gum  over  the  roots 
is  injected,  the  tooth  more  or  less  loose.  Attempts 
at  sealing  the  carious  cavity  by  closing  the  drain- 
age from  the  abscess  provoke  inflammatory  disturb- 
ance. 

15 


106  COMPEND    OF 

52.  What  is  the  prognosis  of  alveolar  abscess? 

Depends  upon  the  amount  of  destruction  of  peri- 
cementum. As  a  rule,  the  prognosis  is  good. 
Alveolar  abscesses  may  persist  for  years,  and  ap- 
parently gain  but  little  headway,  destroying  but  a 
limited  amount  of  tissue.  They  are,  however,  al- 
ways a  menace  to  the  tooth's  retention.  Although 
productive  of  but  slight  local  disturbance  after  a 
fistula  is  established,  they  are  at  all  times  to  be 
viewed  as  possible  centers  of  septic  infection. 

53.  What  is  the  treatment  of  alveolar  abscess? 

Thorough  removal  of  the  cause  and  dead  ma- 
terial, and  establishing  such  conditions  as  will  per- 
mit the  regenerative  process.  The  cause  being  the 
pyogenic  organisms  and  the  decomposing  organic 
matter  in  the  pulp-canal,  dentine,  and  apical  ce- 
mentum,  the  first  step  is  thorough  evacuation  of  the 
contents  of  the  abscess-cavity  and  the  destruction  of 
the  micro-organisms.  If  a  fistula  be  established, 
the  entire  tract,  from  carious  cavity,  through  the 
pulp-canal  into  the  abscess-cavity,  and  out  of  the 
fistula,  is  to  be  freed  of  dead  and  septic  matter. 
Pyrozone  is  injected  through  the  tract,  driving  the 
dead  material  from  all  recesses  out  through  the  fis- 
tula. Sodium  peroxid,  25  per  cent,  sol.,  may  be 
employed,  or  pyrozone,  25  per  cent,  ethereal  solu- 
tion. The  application  should  be  thorough,  to  in- 
sure the  sterilization  of  the  dentine  of  the  root. 
The  application  of  a  powerful  and  persistent  anti- 
septic follows.  Carbolic  acid  alone  is  not  now  used 
with  the  same  freedom  as  it  was  formerly,  for  it  is 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.     10/ 

productive  of  unnecessary  tissue-destruction.  Dr. 
Black's  I,  2,  3  mixture  is  to  be  preferred.  The 
pulp-canal  is  solidly  filled  with  a  cotton  stopping 
which  has  been  saturated  in  the  same  mixture  or 
with  campho-phenique,  and  the  crown-cavity  sealed 
temporarily.  The  case  is  examined  every  few 
days  to  note  the  condition  of  the  fistula.  In  two  or 
three  weeks  the  abscess-cavity  should  be  filled  with 
organized  tissue,  when  the  fillings  of  crown  and 
canal  are  removed  and  replaced  with  permanent 
fillings. 

54,  What  is  the  treatment  of  abscess  without 
fistnla? 

Abscesses  without  fistula  are  evacuated  by  means 
of  pyrozone,  after  a  thorough  cleansing  and  scrap- 
ing of  the  pulp-canal.  The  campho-phenique,  or 
I,  2,  3  mixture,  is  pumped  into  the  sac.  A  loose 
cotton  dressing  is  placed  in  the  pulp-chamber  and 
the  cavity  sealed.  The  dressings  are  removed  every 
second  day,  the  cavity  washed  with  pyrozone,  and, 
if  any  pus  is  found,  subsequently  dressed  with  the 
permanent  antiseptic;  the  cavity  and  canals  are 
dried,  and  the  cotton  and  temporary  stopping  re- 
placed. After  a  week  or  ten  days,  the  cotton  should 
exhibit  no  evidences  of  exudation;  then  canal  fill- 
ings of  cotton  are  placed,  each  succeeding  filling 
being  tighter,  until  a  perfect  stopping  of  this  ma- 
terial is  borne.  The  gum  over  the  root  should  now 
have  returned  to  its  nomial  color. 

55.  How  and  when  are  artificial  fistulse  to  be 
established? 


I08  COMPEND    OF 

Blind  abscesses,  which  exhibit  a  persistent  forma- 
tion of  pus  despite  the  rise  of  antiseptics  tlirough 
the  pulp-canal,  are  to  be  opened  from  the  exterior. 
A  soft,  smooth,  fine  broach,  over  which  a  small  disk 
of  rubber-dam  is  thrust,  is  carried  up  the  pulp-canal 
until  it  penetrates  the  abscess-cavity.  The  length 
of  the  tooth  will  be  indicated  by  the  rubber-dam. 
This  distance  is  measured  upon  the  gums  to  indi- 
cate the  outer  wall  of  the  abscess-cavity.  A  drop  of 
a  lo  per  cent.  sol.  of  cocain  is  injected,  and  in  a  few 
minutes  a  crucial  incision  is  made  through  the  gum 
to  the  process.  A  spear-pointed  drill  is  then  driven 
through  the  wall  into  the  cavity.  The  case  is  now 
treated  as  an  abscess  having  a  fistula.  After  each 
dressing  a  strand  of  floss  silk  is  passed  into  the  ab- 
scess-cavity from  the  gum,  its  end  protruding,  to 
serve  as  a  drain. 

56.  When  and  why  is  the  apex  of  a  root  ampu- 
tated? 

In  cases  of  persistently-open  fistulse  discharging 
serum,  a  probe  passed  through  the  fistula  detects  an 
absence  of  pericementum  from  the  apex  of  the  root ; 
the  cementum  is  found  to  be  rough.  The  apical 
portion  of  the  cementum  is  saturated  with  septic 
material  and  is  necrosed.  The  root-canal  is  to  be 
thoroughly  sterilized  and  filled,  usually  with  gutta- 
percha. The  fistula  is  enlarged  and  free  access 
gained  to  the  abscess-cavity,  enlarging  by  means 
of  antiseptic  tents  frequently  changed.  When  a 
clear  view  of  the  root-apex  is  gained,  a  small  fissure- 
bur  is  employed  to  cut  ofi  that  portion  of  the  root 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     IO9 

projecting  into  the  abscess-cavity.     The  cut  surface 
is  then  smoothed  and  rounded. 

57.  What  is  a  common  effect  of  tlie  operation? 
Faihire  of  the  regenerative  process  to  fill  the  cav- 
ity, the  cut  end  of  the  root  becoming  exposed. 

58.  What  treatment  has  been  suggested  to  pre- 
vent this,  and  why  is  it  not  usually  successful? 

Placing  in  the  cavity  a  sterilized  sponge-graft. 
The  difficulty  of  attaining  the  necessary  asepsis 
usually  causes  failure. 

Calcic  Inflammation  and  Calculi. 

1.  What  is  calcic  inflammation? 

An  inflammation  of  gum  or  pericementum,  or  of 
both,  caused  by  the  deposits  of  calculi  upon  the 
teeth. 

2.  Into  what  two  classes  is  it  divided? 

Into  those  caused  by  salivary  and  those  caused 
by  serumal  calculi. 

3.  What  is  meant  by  salivary  calculi? 

A  deposit  of  the  calcium  salts,  which  have  been 
held  in  solution  in  the  saliva,  about  the  necks  of  the 
teeth. 

4.  What  is  their  composition? 

Mainly  calcium  phosphate  and  carbonate  (over  75 
per  cent.),  water,  and  organic  matter  (22  per  cent.}, 
the  organic  matter  being  largely  mucin. 

5.  How  are  they  formed? 

Their  starting  points  are  usually  at  the  linguo- 
cervical  portion  of  the  lower  incisors,  and  the 
bucco-cervical    aspects    of   the    upper    molars,    the 


lie  COMPEND    OF 

calculi  about  the  lower  incisors  being  more  dense 
than  those  about  the  upper  molars.  From  these 
points  they  extend  over  the  crowns  of  the  teeth,  be- 
tween them,  and  insinuate  themselves  between  gum 
and  tooth. 

6.  What  effects  are  caused  by  them? 

At  the  points  of  contact  with  the  gum  the  latter 
is  seen  to  become  hypereinic,  then  oedematous;  in 
swelling,  the  space  between  the  necks  of  the  teeth 
and  gum  is  enlarged.  The  calculus  encroaches 
upon  this  space;  the  soft  tissues  are  kept  in  a  con- 
stant state  of  irritation,  next  inflammation.  The 
inflammation  affects  the  pericementum  and  alveolar 
process,  and  there  is  an  absorption  of  these  tissues, 
until  finally  the  tooth  is  deprived  of  support,  and  its 
increasing  looseness  is  followed  by  its  loss.  Each 
particle  of  calculus  acts  as  a  destructive  irritant  to 
the  soft  tissues  with  which  it  is  in  contact. 

7.  What  is  the  prognosis  of  this  disorder? 

It  depends  entirely  upon  the  extent  to  which  the 
calculus  has  caused  resorption  of  the  process  and 
destruction  of  the  pericementum,  and  the  thorough- 
ness with  which  the  deposits  may  be  and  are  re- 
moved, 

8.  What  is  the  treatment? 

Removal  by  mechanical  means,  and  smoothing 
the  surfaces  from  which  the  calculi  have  been  re- 
moved. Large  scalers,  formed  to  draw-cut,  are  first 
employed  to  remove  the  larger  masses.  Next,  fine 
scaling  blades,  formed  to  push-cut,  are  applied  over 
the    teeth,    removing    the    finer    particles    and    the 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.     Ill 

closely  adherent  scales.  No  hope  of  cure  is  to  be 
entertained  until  the  last  vestige  of  deposit  has  been 
removed. 

Pyorrhea  Alveolaris. 

1.  What  is  pyorrhea  alveolaris? 

It  is  a  term  applied  to  a  condition  characterized 
by  a  gradual  loss  of  the  pericementum  of  teeth,  an 
atrophy  of  alveolar  walls,  and  attended  by  the  de- 
posit of  calculi  upon  the  roots  of  the  teeth  and  by  a 
flow  of  pus.  The  term  is  faulty  in  that  it  actually 
describes  but  one,  the  last,  symptom. 

2.  What  varieties  of  the  disease  are  met  with 
clinically? 

First,  those  beginning  beneath  the  gum-margin 
and  progressing  toward  the  apices  of  the  roots,  at- 
tended by  the  deposit  of  flat,  smooth,  hard,  dark 
calculi.  Second,  those  beginning  upon  a  lateral 
aspect  of  a  root,  the  gum-margin  at  first  unaffected, 
the  destruction  of  pericementum  radiating  from  the 
first  point  attacked.  Third,  cases  described  by  Dr. 
Black  as  phagedenic  pericementitis,  the  clinical  his- 
tories of  Avhich  are  intimately  associated  with  those 
of  the  second  class. 

3.  What  name  is  given  to  salivary  calculi  and 
those  appearing  just  beneath  the  gingival  margin? 

Ptyalogenic  calculi.     (Peirce.) 

4.  What  other  name  has  been  applied  to  the 
second-named  variety  of  calculi? 

Sanguinary  calculi  (Ingersoll);  serumal  calculi 
(Black). 


112  COMPEND    OF 

5.  What  distinctive  name  has  been  given  the  de- 
posits occurring-  upon  the  lateral  surfaces  of  the 
roots  ? 

Hematogenic  calculi  (Peirce). 

6.  Are  all  of  these  diseases  alike? 

No;  they  differ  in  causes,  clinical  history,  prog- 
nosis, and  treatment. 

Class  One. 

1.  What  are  the  causes  of  the  first  variety  of 
pyorrhea  alveolaris? 

Predisposing  and  exciting.  The  direct  predis- 
posing cause  is  a  catarrhal  condition  of  the  gums, 
produced  by  many  causes,  both  constitutional  and 
local.  The  usual  local  causes  are  overcrowding  of 
the  teeth,  their  malocclusion,  non-occlusion,  or  mal- 
positions. Lack  of  oral  hygiene  is  the  most  pro- 
lific source  of  the  disturbance,  leading  to  the  most 
extensive  destructions.  The  direct  local  cause  is  a 
sub-acute  inflammation  of  the  margins  of  the  gum. 

2.  What  is  the  morbid  anatomy  and  pathology? 
At  the  earliest  stages  the  gum-margins  are  seen 

to  be  swollen,  and  loosened  from  their  attachments 
to  the  necks  of  the  teeth.  A  fine  instrument  passed 
into  the  space  detects  the  presence  of  a  foreign  body 
adherent  to  the  tooth.  There  is  evidence  of  re- 
sorption of  the  alveolar  process  next  to  the  calculus. 
If  the  disease  progresses  very  slowly,  the  outer  peri- 
osteum is  the  seat  of  a  constructive  periostitis,  lead- 
ing to  a  thickening  of  the  process,  while  the  inner 
portion  of  the  alveolar  wall  is  undergoing  atrophic 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     II3 

change.  Pyogenic  cocci  gain  entrance  to  the 
pocket  formed  about  the  parts  by  the  detachment  of 
the  gum,  and  a  progressive  degeneration  of  the  peri- 
cementum occurs.  At  the  termination  of  the  dis- 
ease, when  the  surface  of  the  root  is  incrusted  by 
many  small  deposits,  the  alveolar  walls  absorbed, 
the  pericementum  is  destroyed  everywhere  except 
at  the  apex,  the  tooth  still  being  retained  by  a  small 
Cjuantity  of  fibrous  tissue. 

3.  What  is  the  probable  source  of  the  deposits? 

The  irritated  glands  of  the  inflamed  gingivae  pro- 
duce an  altered  secretion,  which  is  coagulated  by 
the  acid  of  the  lactic  fermentation  of  food  debris; 
lime-salts  from  the  saliva  are  entangled  in  the  coag- 
ulum,  the  form  of  the  calculus  being  due  to  the 
pressure  of  the  overlying  gum.  The  deposits  act  as 
irritants,  which  cause  inflammatory  and,  as  soon  as 
organisms  proliferg,te,  suppurative  degeneration  of 
the  pericementum.  Coincident  with  this  degenera- 
tion is  a  melting  dow^n  of  the  alveolar  walls. 

4.  What  is  the  clinical  history  of  the  disease? 

A  swelling  and  loosening  of  the  gum  from  the 
tooth,  increasing  deposits  upon  the  root,  a  flow  of 
pus  from  beneath  the  gum-margins,  and  a  pro- 
gressive loosening  of  the  tooth  in  its  socket.  Fre- 
quently an  early  symptom  is  a  growing  malposition 
of  a  tooth. 

5.  What  is  the  diagnosis? 

The  onlv  disease  with  which  it  might  be  con- 
founded is  an  alveolar  abscess  discharging  at  the 
gum-margin.     In  the  latter  cases  there  has  usually 

16 


114  COMPEND    OF 

been  a  history  of  acute  apical  pericementitis,  and 
when  the  discharge  of  pus  occurs  a  probe  may  be 
passed  to  the  apex  of  the  root  without  resistance. 
Deposits  of  calcuh  near  the  apex  are  common  when 
these  cases  are  of  long-  standing.  In  pyorrhea  the 
probe  will  meet  with  the  resistance  of  the  still  at- 
tached pericementum,  and  by  careful  examination 
deposits  toward  the  gingival  side  may  be  found, 
even  if  minute. 

6.  What  is  the  prognosis? 

The  disease  may  be  arrested  at  almost  any  stage, 
provided  every  source  of  irritation  be  perfectly  re- 
moved. 

7.  What  is  its  treatment? 

It  is  directed  toward  removing  every  source  of 
irritation,  and  curing  the  morbid  conditions  caused 
by  the  irritation.  The  first  step  is  a  general  sterili- 
zation of  the  mouth,  so  that  pathogenic  organisms 
will  not  be  introduced  into  deep  parts  during  the 
scaling  operation.  The  next  stage  is  sterilization 
of  the  pockets,  syringing  with  3  per  cent,  pyrozone 
in  both  instances.  Next,  a  removal  of  the  deposits 
by  fine  scalers,  used  with  a  push-cut;  heavy  scalers 
should  never  be  employed.  If  the  teeth  are  loose, 
they  are  to  be  immovably  lashed  together,  or  re- 
tained in  position  by  means  of  mechanical  appli- 
ances (swaged  plates,  etc.).  Faults  of  occlusion  are 
corrected  by  grinding  off  redundant  tooth-structure. 
An  antiseptic  and  astringent  mouth-wash  is  to  be 
employed  very  frequently,  until  the  gums  appear  to 
be  reattached  to  the  teeth. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     II5 

Second  Class. 

1.  What  is  phagedenic  pericementitis? 

A  molecular  disintegration  of  the  pericementum 
of  the  teeth;  beginning  near,  but  not  at  the  apex  of, 
the  root,  it  travels  rapidly  toward  the  gingival  mar- 
gin. In  its  early  stages  no  deposits  of  calculi  are 
to  be  detected,  but  later  they  are  usually  found. 
Pus-formation,  although  usually  present,  does  not 
always  occur. 

2.  What  are  its  causes? 
Undetermined. 

3.  What  is  its  clinical  history? 

Usually  a  history  of  a  pericementitis  may  be  elic- 
ited, the  pain  being  obscure  and  indefinitely  located. 
An  examination  may  reveal  a  loosening  of  the  gum 
from  the  neck  of  the  tooth,  and  a  flat  blade  may  be 
passed  for  a  considerable  distance  toward,  in  some 
cases  quite  to,  the  apex  of  the  root.  Testing  the 
tooth  by  applications  of  cold  will  show  the  pulp  to 
be  still  alive.  Melting  down  of  the  alveolar  wall  is 
a  secondary  factor  in  the  history.  The  destruction 
of  pericementum  is  apparently,  first,  of  the  root,  not 
the  alveolar  portion.  In  the  last  stages,  if  a  single- 
rooted  tooth,  the  tooth  may  drop  from  the  shrink- 
ing socket  and  show  an  entire  destruction  of  the 
pericementum. 

4.  What  is  the  pathology  and  morbid  anatomy? 
The  morbid  anatomy  corresponds  with  that  of  the 

occlusion  of  a  pericemental  artery,  followed  by  a 
death  of  cellular  elanents,  and  next  a  degeneration 
of  the  remainder  of  the  pericementum*   and  more 


Il6  COMPEND    OF 

slowly  of  the  alveolar  walls.  The  death  of  a  lateral 
portion  of  the  membrane  and  absorption  of  a 
portion  of  the  alveolar  wall  may  occur  before  there 
is  evidence  of  disease  at  the  gum-margin. 

5.  What  is  the  diagnosis? 

A  loosening  of  a  tooth  without  evident  cause, 
such  as  mechanical  irritation,  death  of  the  pulp,  or 
deposits  of  subgingival  calculi.  An  attempt  is  made 
to  pass  an  instrument  up  into  the  alveolus  from  the 
gum-margin.  If  this  be  firmly  adherent  and  the 
margins  of  the  alveolus  intact,  a  sharp  probe  may 
be  passed  through  the  gum  to  detect  an  absence  of 
alveolar  wall. 

6.  What  is  the  prognosis? 
Usually  unfavorable. 

7.  What  is  its  treatment? 

The  principle  of  treatment  is  the  removal  of  dead 
and  foreign  materials  and  the  inducing  of  tissue- 
regeneration  to  restore  lost  parts. 

Third  Class. 
Gouty  Pericementitis. 

1.  What  is  the  third  variety  of  pyorrhea  alve- 
olaris? 

Hematogenic  calcic  pericementitis. 

2.  Into  what  are  its  causes  divided? 
Predisposing  and  exciting,  and  into  immediate 

and  remote.  The  remote  causes  are  any  which  ren- 
der the  pericementum  a  weakened  articulative  tis- 
sue; they  are  the  predisposing  causes.  The  great 
majority  of  cases  observed  have  affected  the  teeth 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     II7 

of  persons  who  are  the  victims  of  the  gouty  dia- 
thesis, wliicli  diathesis  is  regarded  as  the  predis- 
posing cause.  The  exciting  cause,  in  the  majority 
of  cases,  is  the  deposit  of  calcuH  upon  or  in  some 
portion  of  the  pericementum  lying  between  the 
apex  of  the  root  and  tlie  gum-margin,  although  a 
degeneration  of  the  membrane  does  and  may  occur 
without  the  presence  of  perceptible  calculi. 

3.     What  is  the  clinical  history  of  the  disease? 

Very  frequently  that  described  under  the  head  of 
phagedenic  pericementitis.  The  history  of  a  typical 
case  may  extend  over  a  period  of  years.  There  is  a 
personal  or  a  family  history  of  gout.  Obscure  neu- 
ralgic pains  have  been  felt  in  and  about  the  jaws  for 
some  time,  particularly  at  night.  One  or  more  teeth 
may  be  seen  to  shift  position  without  evident  local 
cause.  The  teeth  are  but  little,  if  any,  affected  by 
dental  caries.  The  teeth,  one  or  more,  will  give 
evidence  of  pericemental  inflammation,  as  though 
an  alveolar  abscess  were  forming,  as  frequently  it  is. 
Thermal  test  shows  the  afifected  tooth  to  contain  a 
vital  pulp.  The  discharge  from  the  focus  of  in- 
flammation may  make  its  way  directly  through  the 
gum,  or  burrow  along  the  pericementum  and  dis- 
charge at  the  neck  of  the  tooth.  The  acute  in- 
flammatory symptoms  in  other  cases  may  subside. 
In  either  event  the  tooth  loosens  progressively,  and 
an  instrument  passed  through  the  gum  reveals,  at 
times,  a  loss  of  alveolar  wall  over  a  portion  of  the 
root,  and  usually  the  presence  of  a  calculus. 
Should  the  discharge  be  at  the  neck  of  the  tooth, 


Il8  COMPEND    OF 

the  calculus  may  be  detected  by  passing  a  probe  by 
that  way.  If  these  deposits  be  removed,  washed, 
and  tested,  they  will  be  found  to  respond,  at  times, 
very  faintly  to  the  murexid  test,  showing  the  pres- 
ence of  urates. 

4.  What  is  the  morbid  anatomy  and  pathology? 
If  teeth   are  extracted  soon  after  inflammatory 

symptoms  present  themselves,  it  is  usual  to  find 
the  cervical  portion  of  the  pericementum  intact;  at 
some  point  of  the  apical  half  a  calculus  may  be 
noted  at  times,  evidently  attached  to  the  cementum ; 
in  other  cases  the  deposit  may  be  in  the  pericemen- 
tum; surrounding  the  deposit  is  an  area  of  necrotic 
tissue.  It  is  presumed  that,  as  a  feature  of  the 
gouty  process,  an  arterial  twig  or  twigs  have  be- 
come occluded,  and  a  death  of  cellular  elements  en- 
sues; the  necrotic  area  acquires  an  acid  reaction, 
which  causes  the  precipitation  of  urates  in  the  area. 
These  deposits  and  the  necrotic  tissues  act  as  irri- 
tants, and  an  inflammation  is  induced  which  is  fol- 
lowed by  a  degeneration  and  necrosis  of  the  peri- 
cementum and  a  degeneration  or  melting  down  of 
the  alveolar  walls.  Pyogenic  organisms  gain  en- 
trance to  the  disease  area,  and  the  tissue  loss  is 
hastened  by  the  suppurative  process.  Accretions  to 
the  primary  calculus  occur,  which  are,  as  a  rule, 
composed  of  calcium  phosphate,  combined  with  the 
morbid  secretions  of  the  part,  forming  adherent  cal- 
culi. 

5.  What  is  the  diagnosis? 

A  patient  from  whom  a  clear  gouty  history  may 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     II9 

be  elicited  presents  with  one  or  more  teeth  exhibit- 
ing looseness.  The  gum-marg-ins  are  apparently 
unaffected,  although  in  some  cases  pus  may  be  ex- 
uding from  the  alveoli;  in  other  cases,  a  serous  fluid. 
An  absence  of  caries  is  usually  noted,  no  local 
causes  existing  which  would  explain  the  disease 
process. 

6.  What  is  the  prognosis? 

As  a  rule,  not  good,  although  patients  who  have 
suffered  from  nocturnal  maxillary  neuralgia,  loose- 
ness of  teeth,  and  in  some  cases  even  morbid  dis- 
charge from  about  the  necks  of  the  teeth,  have  had 
the  symptoms  disappear  through  an  observance  of 
an  anti-gout  regimen  and  the  administration  of  anti- 
gout  remedies,  without  any  local  measures  being 
employed.  The  prognosis  is  governed,  as  in  any 
other  disease,  by  the  extent  to  which  causes  predis- 
posing and  exciting,  remote  and  immediate,  may  be 
removed  and  the  effects  of  their  action  remedied. 
The  more  advanced  the  case,  the  worse  the  prog- 
nosis. As  a.  rule,  the  process  eventually  causes  the 
loss  of  every  affected  tooth. 

7.  What  is  the  treatment? 

It  is  divided  into  general  and  local.  The  general 
therapeutics  is  directed  toward  the  elimination  or 
washing  out  of  waste  products  through  bowels  and 
kidneys,  and  increasing  the  alkalinity  of  the  blood. 
In  acute  cases  colchicum  may  be  prescribed;  in  the 
chronic  cases,  potassium  iodid.  The  administra- 
tion (continued)  of  lithia  waters  is  recommended. 
The  bitartrate  of  lithium,  gr.  v  ter  die,  serves  as 


I20  COMPEND    OF 

an  eliminant  and  increases  the  alkalinity  of  the 
blood.  What  is  described  in  the  text-books  upon 
general  therapeutics  as  an  anti-gout  regimen  should 
be  rigidly  followed.  White  meats  and  fish  are  sub- 
stituted for  beef.  Alcoholic  liquors  are  to  be  es- 
chewed. Open-air  exercises  are  advised  to  increase 
the  oxidizing  function.  Succulent  vegetables  are 
substituted  for  starchy  vegetables,  as  the  latter  un- 
dergo fermentative  changes  in  the  stomach  and 
perpetuate  a  common  feature  of  gouty  maladies  and 
gastric  disorders.  The  local  therapeutics  is  di- 
rected to  the  surgical  conditions  present.  First, 
any  faulty  or  excessive  occlusion  should  be  cor- 
rected. Second,  loose  teeth  should  be  placed  in 
splints  (ligatures,  plates,  or  other  devices).  Third, 
the  thorough  removal  of  all  deposits.  This  opera- 
tion is  in  some  cases  impossible;  the  deposits  are 
too  firmly  adherent  for  removal  by  instrumental 
means,  and  solvents  are  inefificient.  Fourth,  pus 
and  organisms  are  to  be  destroyed.  Pyrozone, 
small  amounts  of  25  per  cent,  on  wisps  of  cotton, 
is  most  eflfective.  Fifth,  the  loose  tissues  are  con- 
tracted and  the  congestion  lessened  by  means  of  the 
continued  use  of  an  astringent  and  antiseptic — zinc 
chlorid  or  iodid,  gr.  iii,  water  oz.  i. 

Erosion  of  the  Teeth, 

1.  What  is  dental  erosion? 

A  progressive  chemical  solution  of  the  faces  of 
the  teeth,  not  due  to  caries  or  mechanical  abrasion. 

2.  What  is  its  cause? 

Patients  are  usually  the  victims  of  the  gouty  dia- 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     121 

thesis.     An  altered  secretion  of  the  labial  follicular 
glands,  acid  in  reaction,  is  probably  the  solvent. 

3.  What  is  its  morbid  anatomy? 

-The  labial  faces  of  the  teeth  are  commonly  at- 
tacked; an  area  becomes  denuded  of  enamel;  during 
solution  its  surfaces  remain  polished;  the  invasion 
of  the  dentine  is  less  rapid  than  is  the  surface  loss 
of  enamel,  so  that  cup-shaped  excavations  are 
formed.  The  morbid  anatomy  is  distinctive  from 
that  of  dental  caries.  Occasionally  the  denuded 
surfaces  become  hypersensitive;  its  progress  may 
expose  the  pulp,  or  a  constructive  action  may  oblit- 
erate the  pulp  as  the  disease  advances.  The  ero- 
sion may  proceed  until  the  teeth-crowns  are  ampu- 
tated. In  other  cases  the  process  appears  to  be 
self-limited.  When  the  worn  areas  are  restored  by 
means  of  filling-materials,  the  erosion  persists 
about  the  edges  of  the  fillings. 

4.  What  is  its  diagnosis? 

This  peculiar  tooth-loss  occurring  in  dentures  in- 
susceptible to  dental  caries. 

5.  What  is  its  treatment? 

The  persistent,  continued  use  of  alkaline  appli- 
cations and  alkaline  mouth-washes.  Phillips's  milk 
of  magnesia.  The  destruction,  by  electrical  cautery, 
of  the  aiTected  glands  has  been  suggested.  Cavities 
may  be  filled  to  protect  the  dentine,  but  the  solution 
of  enamel  proceeds  around  their  margins. 

Dental  Pharmacology  and  Materia  Medica. 
I,     Into  what  two  great  classes  may  all  remedial 
agents  be  placed? 

17 


122  COMPEND    OF 

Stimulants  and  sedatives.  Stimulants  are  agents 
which  increase  the  activity  of  some  one  or  more 
of  the  vital  functions.  Sedatives  are  those  which 
depress  functions. 

2.  Under  what  three  heads  may  nearly  all  dental 
medicaments  be  placed? 

Antiseptics,  anesthetics,  and  astringents. 

Antiseptics. 

1.  What  is  an  antiseptic? 

It  is  an  agent  which  prevents  the  action  of  path- 
ogenic organisms  and  their  products  upon  living 
tissues. 

2.  What  is  a  germicide? 

It  is  an  agent  which  prevents  sepsis  by  destroying 
the  organisms.  All  germicides  are  antiseptics,  but 
all  antiseptics  are  not  necessarily  germicides.  Iodo- 
form is  an  antiseptic,  but  not  a  germicide. 

3.  What  antiseptics  are  commonly  employed  in 
dental  practice? 

Salts  of  metals:  the  chlorids  of  zinc,  mercury, 
and  aluminum;  sulfate  of  copper;  nitrate  of  sil- 
ver. Alcohols  and  their  derivatives:  ethyl,  or  com- 
mon alcohol,  phenylic  alcohol  (carbolic  acid,  crea- 
sote,  trikresol,  and  lysol).  Formic  aldehyde  (for- 
maldehyde). The -essential  oils — of  cloves,  cajuput, 
cassia,  cinnamon  (cassia  being  the  oil  from  the 
Chinese,  the  latter  the  oil  of  the  Ceylon  cinnamon), 
eucalyptus,  eugenol,  and  myrtol.  Solutions  from 
which  nascent  oxygen  is  evolved :  hydrogen  dioxid, 
pyrozone  in  3  per  cent.,  5  per  cent.,  and  25  per  cent. 


DENTAL  PATHOLOGY  AND  THERAPEUTICS.  I23 

solutions,  the  latter  two  in  ether.  Solutions  of 
sodium  peroxid.  Strong  alkalies:  the  alloy  of 
sodium  and  potassium  (kalium  natrium),  sodium 
carbonate,  potassium  carbonate,  and  sodium  hy- 
drate, produced  from  sodium  peroxid.  The  mineral 
acids,  hydrochloric,  chromic,  nitric,  and  sulfuric. 
Organic  acids,  acetic  (glacial)  and  the  trichlor- 
acetic. Solutions  containing  hypochlorites  (Labar- 
raque's)  and  solutions  of  hyposulfites.  Iodoform, 
iodol,  and  kindred  substances  have  limited  appli- 
cation. 

4.  How  do  the  salts  of  metals  act  as  germicides? 
By   forming  albuminates   of  the   several   metals 

when  the  latter  are  brought  in  contact  with  proto- 
plasm. 

5.  In  what  form  and  strength  are  they  em- 
ployed? 

Usually  in  watery  solution,  and  in  strength  sufifi- 
cient  to  destroy  micro-organisms,  but  insufficient  to 
kill  the  cells  of  tissues.  Mercuric  chlorid,  in  1-2000 
to  1-500  sol.,  to  which  is  added  ammonium  chlorid 
to  hold  the  mercury  salt  in  solution.  Zinc  chlorid 
is  employed  in  1-40  sol. 

6.  How  do  the  alcohols  act? 
They  coagulate  albuminous  matter. 

7.  In  what  strengths  are  they  employed? 
Ethylic  (commercial)  alcohol  is  used  in  95  per 

cent,  strength.  Phenylic  alcohol  is  used  in  from  5 
])er  cent,  to  95  per  cent,  strength.  The  kresols  the 
same;  also  lysol.  Campho-phenique,  a  substance 
formed  by  the  addition  of  carbolic  acid  to  gum  cam- 
phor, is  used  full  strength. 


124  COMPEND    OF 

8.  How  do  the  essential  oils  act? 

As  protoplasmic  poisons,  without  coagulatinq- 
albuminous  matter.  They  differ  in  germicidal 
power.  The  oils  of  cinnamon  and  myrtol  appear 
to  possess  the  greatest  measure  of  power.  Thymol 
has  marked  germicidal  power.  The  oils  of  cloves 
and  eugenol,  of  eucalyptus,  of  gaultheria,  have  less 
action. 

9.  How  does  nascent  oxygen  act? 
It  chemically  destroys  septic  matter. 

10.  How  is  hydrogen  peroxid  used,  and  in  what 
strength? 

The  commercial  forms:  15  vol.  sol.  is  contained 
in  an  aqueous  solution,  usually  more  or  less  acid  in 
reaction;  3  per  cent,  pyrozone  is  a  neutral  solution. 
In  these  strengths  preparations  may  be  used  undi- 
luted. The  5  per  cent.  sol.  of  pyrozone  in  ether  is 
slightly  caustic.  The  25  per  cent.  sol.  in  ether  is 
promptly  but  superficially  caustic;  it  is  used  in 
small  quantities  undiluted. 

11.  What  other  marked  and  desirable  effect  has 
nascent  oxygen? 

It  is  a  bleacher.  Bleaching  is  evidence  of  perfect 
sterilization. 

12.  How  is  it  prepared  for  this  purpose? 

It  is  placed  in  the  dried  cavity  of  a  tooth  in  25  per 
cent,  ethereal  solution,  or  the  latter  is  mixed  with 
an  equal  bulk  of  water  and  evaporated  one-half,  giv- 
ing a  25  per  cent,  acjueous  sol.  of  pyrozone. 

13.  What  is  the  action  of  sodium  peroxid,  how 
employed,  and  in  what  strengths? 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.     I25 

It  is  used  in  from  25  per  cent,  solution  to  full 
strength,  or  in  dry  powder.  The  powder  is  slowly 
sifted  in  distilled  water  at  32°  F.  until  a  saturated 
solution  is  made,  which  is  then  diluted  as  required. 
In  the  presence  of  organic  matter  the  sodium  per- 
oxid  is  decomposed,  forming  nascent  oxygen  and 
sodium  hydrate.  The  oxygen  acts  as  a  germicide 
and  bleacher;  the  sodium  hydrate  saponifies  fatty 
and  dissolves  albuminous  matters. 

14.  How  does  the  alloy  of  sodium  and  potassium 
act? 

In  contact  with  organic  matter  it  seizes  upon  the 
hydrogen  and  oxygen  of  such  matter,  forming 
sodium  and  potassium  hydrate. 

15.  How  do  the  mineral  acids  act?  How  are 
they  employed,  and  in  what  strength? 

Hydrochloric  acid  is  used  but  little.  In  10  per 
cent,  solution  it  may  be  employed  to  neutralize 
powerful  alkalies.  Used  after  applications  of  sodium 
peroxid,  it  forms  sodium  chlorid,  setting  free  the 
oxygen.  Sulfuric  acid  chemically  decomposes 
organic  matter,  dehydrating  it.  It  is  used  in  50 
per  cent,  solution  (Callahan)  for  opening  and  en- 
larging the  fine  and  tortuous  pulp-canals  of  teeth. 
Nitric  acid  is  used  in  rare  instances  to  cauterize 
hypersensitive  dentine.  Its  usual  office  is  for  the 
cauterization  of  sluggish  ulcers.  In  both  cases  it 
is  employed  full  strength.  Chromic  acid  (deli- 
quesced) is  used  for  the  same  purpose,  but  seldom. 
Acetic  (glacial),  lactic,  and  trichloracetic  acid  de- 
stroy organic  matter,  and  are  almost  painlessly 
caustic. 


126  COMPEND    OF 

1 6.     What  is  aromatic  sulfuric  acid? 

A  solution  of  alcohol,  sulfuric  acid,  and  several 
aromatics.  The  alcohol  is  transformed  into  sul- 
furic ether. 

Anesthetics. 

1.  What  are  anesthetics? 

Agents  which  diminish  the  reception,  transmis- 
sion, or  perception  of  impressions  which  would 
cause  pain. 

2.  How  are  they  divided? 
Into  general  and  local. 

3.  What  are  general  anesthetics? 

Those  which  prevent  pain  by  temporarily  abolish- 
ing consciousness. 

4.  What  are  local  anesthetics? 

Those  which  prevent  pain  by  the  benumbing  of 
chosen  areas  of  the  body. 

5.  What  are  most  common  of  the  general  anes- 
thetics? 

Chloroform,  sulfuric  ether,  and  nitrous  oxid. 

6.  What  local  anesthetics  are  employed  in  den- 
tistry? 

Refrigerants,  such  as  a  spray  of  rhigolene,  ethyl 
or  methyl  chlorid,  or  pental,  which,  by  their  ra])id 
evaporation,  cause  analgesia  by  freezing;  cocain, 
which  acts  as  a  paralyzant  of  nerve  terminals  with 
which  it  is  brought  in  contact;  tropacocain,  and 
eucaine. 

7.  How  is  cocain  employed? 

'  Epidermically,  applied  to  a  mucous  surface;  or 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     1 27 

hypodermically,  injected  beneath  the  skin,  and  pro- 
ducing anesthesia  over  a  greater  or  less  area. 

8.  AA^hat  precautions  are  to  be  taken  in  using 
cocain  or  its  preparations? 

To  inject  not  more  than  the  minimum  physiolog- 
ical dose,  never  more  than  gr.  -};  to  make  the  in- 
jection under  the  strictest  antiseptic  precautions, 
and  to  combine  in  the  prescription  agents  which  will 
neutralize  the  ill  effects  of  the  cocain,  its  paralyzant 
action  upon  heart  and  respiration,  and  also  an 
antiseptic. 

9.  What  are  these  agents? 

A  I  per  cent,  solution  of  nitroglycerin  and  mor- 
phia. 

R — Cocain,  gr.  1-3; 

Sol.  nitroglycerin,  gtt.  j  of  i  per  cent.  sol. ; 
Morphinse  sulph.,  gr.  i-io; 
Listerine, 

Aquge,  aa  dr.  i. — M. 
ID.     AVhat  other  effective  method  is  there  for  in- 
troducing cocain  into  the  tissues? 
Cataphoresis. 

11.  What  is  cataphoresis? 

It  is  the  introduction  of  drugs  into  tissues  by 
means  of  the  electric  current.  A  drug  in  solution 
is  driven  by  the  current  from  the  positive  toward 
the  negative  pole. 

12.  How  is  cataphoresis  to  be  distinguished 
from  electrolysis? 

In  the  latter  the  drug  is  decomposed  into  its 
chemical  elements,  which,  according  to  their  electric 


125  COMPEND    OF 

relations,  are  attracted  to  either  positive  or  negative 
poles.  In  the  former  process  the  drug  is  driven 
bodily  from  the  positive  to  the  negative  pole  with- 
out decomposition. 

13.  What  are  obtundents? 

Agents  which  relieve  existing  pain;  they  are 
local  anesthetics  or  analgesics,  and  have  various 
modes  of  action. 

14.  Give  examples. 

Zinc  chlorid  and  silver  nitrate,  both  powerful 
cauterants,  obtund  the  sensitivity  of  dentine.  They 
chemically  destroy  the  sensitive  terminals  through 
which  pain  is  received.  The  oils  of  cloves,  gaul- 
theria,  cinnamon,  or  cassia  benumb  the  same  fibers. 
The  mild  alkalies  obtund  by  neutralizing  irritating 
acids.  Carbolic  acid  and  kindred  substances  are 
specific  obtundents,  but  destroy  the  obtunded  tissue. 

15.  What  are  anodynes? 

Another  class  of  anesthetics,  to  which  morphia, 
atropia,  aconitia,  veratria,  and  gelsemium  belong. 
The  first  of  the  group  is  the  true  anodyne;  it  lessens 
pain  v/ithout  necessarily  destroying  consciousness. 
The  abolishment  of  pain  is  a  secondary  factor  with 
the  other  alkaloids  named. 

16.  Name  other  true  general  anodynes. 

The  coal-tar  derivatives,  phenacetin  and  acetan- 
ilid,  with  its  preparations,  antikamnia,  ammonol, 
etc. 

xj.     When  arc  anodynes  employed? 

To  lessen  or  abolish  neuralgic  pain,  the  exact  ori- 
gin of  which  is  unknoAvn,  or  being  known  cannot 
be  removed  by  means  of  local  applications. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     I29 

18.  What  objection  is  there  to  the  use  of  the 
powerful  alkaloids? 

Disagreeable  and  undesirable  constitutional  ef- 
fects. 

19.  A¥hat  is  the  danger  in  using  the  coal-tar 
derivatives  ? 

They  depress  the  heart's  action.  For  that  reason, 
animonol,  which  contains  a  cardiac  stimulant,  is 
usually  preferable.     The  dose  is  about  ten  grains. 

20.  What  is  the  most  common  use  of  these 
agents? 

To  relieve  attacks  of  hemicrania  (sick-headache). 

21.  What  is  their  mode  of  action? 
It  is  unknown. 

A'stringents. 

1.  What  are  astringents? 

Agents  which  cause  contraction  of  tissues  to 
which  they  are  applied. 

2.  How  are  they  divided? 
Into  vegetable  and  mineral. 

3.  To  what  do  the  vegetable  astringents  owe 
their  efficacy? 

To  the  presence  of  tannic  acid. 

4.  For  what  purpose  are  they  usually  em- 
ployed? 

As  styptics,  to  arrest  minor  hemorrhage. 

5.  For  what  other  purpose  are  they  nstdl 

As  constituents  of  mouth-washes  for  flabby  con- 
ditions of  the  mucous  membrane. 

6.  What  preparations  are  employed? 

18 


130  COMPEND    OF 

Ext.  hamaraelis  Virginica;  solutions  of  tannic  or 
gallic  acid;  infusions  of  white  oak  (Quercus  alba); 
tinctures  of  kino,  krameria,  and  of  myrrh. 

7.  Why  are  infusions  preferable  to  tinctures? 
Tinctures  contain  gums  insoluble  in  water,  which, 

when  employed  as  mouth-washes,  are  precipitated 
about  the  necks  of  the  teeth. 

8.  What  metallic  astringents  are  employed  in 
dentistry? 

Solutions  of  zinc  chlorid,  gr.  ii-oz.  j ;  solutions 
of  alum;  solution  of  the  subsulfate  of  iron  (Mon- 
sel's  solution),  the  tincture  of  the  chlorid  of  iron; 
alum,  and  the  subacetate  of  lead. 

9.  W^hat  are  their  uses? 

With  the  exception  of  the  first  and  last,  they  are 
used  as  styptics  in  the  arrest  of  alveolar  hemor- 
rhage. The  zinc  chlorid  solution  is  used  as  an 
astringent  and  antiseptic;  the  lead  salt,  dissolved 
in  water  dr.  j-Oj,  is  used  as  an  antiphlogistic  exter- 
nally. The  salts  mentioned  as  styptics  contain 
more  or  less  free  acid,  which  is  destructive  to  the 
teeth. 

Dental  Medicine  Cabinet. 
Mark  all  poisons  POISON. 
Acetanilid,   combined  with   sodium  bicarb,   and 
cafifein  citrate  fantikamnia),  in  5  gr.  tablets. 

For  the  relief  of  neuralgic  pain,  one  pellet  every 
three  hours  up  to  five  pellets. 

Acid  Acetic.  In  dentistry  the  trichloracetic  acid 
is  used.     Full  strength  to  destroy  tissue  (caustic), 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.     I3I 

to  remove  fungous  gum,  destroy  fungous  pulp,  to 
destroy  gum  flaps  overlying  iitiprisoned  lower  third 
molars^  to  destroy  small  remnants  of  vital  pulps. 
In  25  per  cent,  solution  it  is  used  to  soften  the 
deposits  of  serumal  calculi,  to  check  oozing,  and 
permit  a  better  view  of  the  pockets. 

Acid  Boric.  A  mild  antiseptic  powder;  in  solu- 
tion an  ingredient  of  antiseptic  mouth-washes. 

Acid  Carbolic  (Phenylic  Alcohol).  In  crystals 
or  fluid  it  is  a  caustic,  used  principally  in  dentistry 
to  cauterize  canker  sores.  They  are  dried,  and  the 
acid  (a  crystal)  pressed  against  the  sore  until  it  is 
white.  As  an  antiseptic  it  is  employed  full  strength 
to  sterilize  the  dentine,  as  an  antiseptic  canal-dress- 
ing, an  application  to  abscess-cavities.  (It  is  com- 
bined for  this  purpose  with  oil  of  cinnamon  i  part, 
carbolic  acid  2  parts,  ol.  gaultheria  3  parts — Black's 
T,  2,  3  mixture).  As  an  obtundent  of  hypersensi- 
tive dentine  it  is  used  full  strength.  In  5  per  cent, 
watery  solution  it  is  in  common  use  for  antiseptic 
irrigation. 

Acid  Chromic.  A  powerful  caustic,  rarely  used 
in  dentistry,  although  at  one  time  the  deliquesced 
acid  was  used  as  an  obtundent  and  caustic. 

Acid  Hydrochloric  (10  per  cent.).  Used  with 
sodium  peroxid  to  suddenly  disengage  oxygen. 

Acid  Nitric  (fuming).  As  a  caustic  for  canker 
sores,  for  which  purpose  it  has  been  replaced  by 
carbolic  acid;  to  obtund  the  hypersensitivity  of  the 
abraded  dentine  upon  the  articulating  faces  of  teeth 
previous  to  excavation. 


132  COMPEND    OF 

Acid  Oxalic.  Used  to  liberate  chlorin  from 
chlorinated  lime  in  the  bleaching  of  teeth.  Mark 
poison,  as  it  closely  resembles  Epsom  salts. 

Acid  Phosphoric.  A  solution  of  the  ortho-phos- 
phoric acid  is  the  fluid  of  zinc  phosphate  cement. 

Acid  Salicylic.  An  antiseptic  largely  fallen  into 
disuse  except  as  a  constituent  of  mouth-washes. 

Acid  Sulfuric.  In  50  per  cent,  solution  used  to 
effect  an  entrance  to  minute  and  tortuous  pulp- 
canals;  it  is  pumped  into  the  canal  by  means  of 
Donaldson's  cleansers.  It  is  also  an  efficient  anti- 
septic in  the  same  connection. 

Acid  Sulfuric,  Aromatic.  It  is  in  part  an  ether. 
It  is  formed  by  the  combination  of  sulfuric  acid, 
alcohol,  and  aromatics.  It  is  used  full  strength  to 
dissolve  carious  bone,  and  diluted  as  a  stimulating 
wash. 

Acid  Tannic  (in  powder).  Applied  to  bleeding 
alveoli  to  arrest  hemorrhage. 

Aconite.  The  tincture  of  the  root  is  used  in  com- 
bination with  tine,  iodin  to  relieve  pericementitis. 
Evaporated  to  one-fourth  its  volume,  it  forms  the 
dental  tincture  of  aconite  (hlagg),  a  powerful  local 
paralyzant.  One-drop  doses  of  the  officinal  tinc- 
ture are  given  in  water  every  hour  to  depress  the 
action  of  the  heart  in  the  constitutional  treatment 
of  inflammation. 

Alcohol.  Used  as  a  solvent  of  gums  to  form 
varnishes;  to  alDStract  water  from  parts  and  ]iroduce 
desiccation,  particularly  a  sui)erficial  desiccation  of 
the  dentine  prior  to  root-fllling.     It  is  evaporated 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     I33 

rapidly  by  means  of  a  hot  blast.  Alcohol  is  a  pow- 
erful astringent.  Methyl  alcohol  is  employed  to 
dissolve  di-nitro  cellulose  to  form  a  non-conducting 
varnish. 

Ammonii  Carbonate.  In  the  form  of  smelling- 
salts,  as  a  quick  cardiac  stimulant  in  cases  of  faint- 
ness. 

Amyl  Nitrite.  Keep  in  glass  pearls  of  np,  iii  each. 
In  cases  of  pale  face,  cold  extremities,  and  cardiac 
spasm  one  of  the  pearls  is  crushed  in  a  handkerchief 
and  the  nitrite  inhaled.  It  is  the  antidote  for  the 
evidence  of  chloroform-poisoning. 

Argenti  Nitras  (Nitrate  of  Silver).  In  crystals, 
used  as  an  obtundent  upon  the  abraded  faces  of 
teeth;  as  an  antiseptic  canal  application  for  chil- 
dren's temporary  teeth;  as  a  caustic  for  canker 
sores.  In  from  4  to  lo  per  cent,  solution  it  is  used 
as  a  stimulant  and  antiseptic  application  to  mucous 
surfaces. 

Aristol  (di-thymol  iodid).  A  powerful  antiseptic, 
containing  iodin  and  thymol ;  it  has  largely  replaced 
iodoform,  being  odorless  and  a  more  powerful  anti- 
septic. The  powder  is  soluble  in  ether  and  oils. 
As  a  canal  dressing  it  is  dissolved  in  oil  of  cin- 
namon. 

Arsenic.  The  trioxid  (arsenious  acid)  is  com- 
bined with  an  equal  quantity  of  cocain  hydro- 
chlorate  and  sufhcient  oil  of  cinnamon  to  make  a 
paste.  The  paste  is  used  in  minute  quantities  to 
devitalize  the  pulps  of  teeth.  Arsenic  has  a  power- 
ful  paralyzing  action   upon   the   pulp;   the   liquor 


134  COMPEND    OF 

potassii  arsenitis  (Fowler's  solution)  will  paralyze 
the  sensory  filaments  in  the  dentine,  and  presum 
ably  destroy  a  pulp.     The  formula — 
R — Acid,  arseniosi, 

Cocain  hydrochlor.,  oa; 

Ol.  cinnamon,  q.  s.     Ft.  paste, 

has  largely  superseded  the  old  formula — 
R- — Acid,  arseniosi, 
Morph.  acet,  aa; 
Acid,  carbolic,  q.  s.     Ft.  paste. 

Capsicum.  Is  used  as  a  stimulant  and  counter- 
irritant.  As  a  stimulant,  a  few  drops  of  the  tinc- 
ture are  placed  in  sterilized  water  or  a  solution  of 
listerine,  and  used  as  a  mouth-wash  or  a  stimulating 
injection  where  tissue-regeneration  is  in  progress, 
but  is  sluggish.  As  a  counter-irritant,  the  pow- 
dered capsicum  is  mixed  with  powdered  ginger  and 
made  into  pepper-bags.  These  are  at  present  most 
commonly  used  in  cases  of  chronic  or  transient 
pericementitis. 

Campho-phenique.     A  preparation  made  by  mix- 
ing- 
Gum  camphor, 


Carbolic  acid, 

It  possesses  the  properties  of  carbolic  acid  with- 
out being  cauterant.  It  is  a  stimulating  antiseptic, 
— stimulating  to  tissue-growth,  but  sedative  as  to 
sensory  function. 

Chloral  Hydrate.     In  20  per  cent,  watery  solu- 


DENTAL    PATHOLOGY   AND    THERAPEUTICS.     I35 

tion,  a  powerful  counter-irritant;  in  i  per  cent,  solu- 
tion, a  stimulating  injection.  As  a  hypnotic,  gr.  x 
camphor  and  chloral,  aa,  is  a  useful  local  appli- 
cation for  the  relief  of  neuralgia.  It  is  applied  ex- 
ternally for  the  relief  of  pains  attendant  upon  diffi- 
cult eruption  of  the  lower  third  molar. 

Chloroform.  Excluded  from  use  as  an  anes- 
thetic in  dental  operations  on  account  of  the  at- 
tendant dangers.  Applied  upon  cotton  it  will  fre- 
quently relieve  the  pain  of  pulpitis. 

Cocain  Hydrochlorate.  Maximimi  dose  for  use 
in  dentistry,  gr.  |;  used  in  4  per  cent,  aqueous 
solution  as  a  local  anesthetic  for  mucous  surfaces. 
Combined  in  the  following  prescription  it  is  used  as 
an  injection  for  the  painless  extraction  of  teeth: 

R — Cocain  hydrochl.,  gr.  i~6; 
Morph.  sulph.,  gr.  1-16; 
Sol.  nitroglyc,  i  per  cent.,  gtt.  j; 
Listerine,  q.  s.     Ft.  ^j. — M. 

The  injection  is  made  over  the  roots  of  the  teeth. 
Cocain  is  an  ingredient  of  arsenical  paste.  A  spray 
of  2  per  cent,  solution  is  used  to  benumb  the  soft 
palate  prior  to  taking  impressions  in  cases  of  irri- 
table palate. 

Creasote.     Same  uses  as  carbolic  acid. 

Ethyl  Chlorid.  In  sealed  tubes.  A  spra}^  is  used 
as  a  refrigerant  anesthetic  for  tooth-extraction  and 
to  benumb  hypersensitive  dentine. 

Iodoform.  In  powder  and  in  5  per  cent,  ethereal 
solution  as  an  antiseptic,  but  not  a  germicide.     It 


136  COMPEND    OF 

is  believed  that  in  contact  with  the  tissues  iodin  is 
Hberated  from  iodoform  and  acts  as  an  antiseptic. 
Iodoform  is  sedative.  Its  odor  may  be  disguised 
by  mixing-  with  oil  of  cinnamon. 

lodol.  Properties  and  uses  similar  to  those  of 
iodoform. 

Iodin.  In  tincture  is  a  counter-irritant,  astrin- 
gent, and  antiseptic,  in  the  latter  office  particularly 
useful  in  the  last  stages  of  putrefactive  decomposi- 
tion. In  strong  tincture,  combined  with  tr.  aconite, 
it  is  applied  to  the  gums  in  chronic  pericementitis 
as  a  counter-irritant.  In  diluted  tincture  it  is  ap- 
plied as  an  antiseptic  and  astringent  in  cases  of  con- 
gestion of  the  gums  and  pyorrhea  alveolaris. 

Magnesium  Hydrate,  MgH^O^.  Used  as  an 
antacid  mouth-wash,  particularly  in  cases  of  ero- 
sion; a  film  of  magnesium  hydrate  being  deposited 
upon  the  eroded  areas  protects  them  from  the  ac- 
tion of  the  eroding  acid. 

Menthol.  Crystals,  as  an  obtundent  in  cases  of 
pulpitis;  made  into  pencils  with  cerates,  to  relieve 
neuralgia  by  painting  over  the  painful  tract. 

Oil  Cajuput.  It  is  obtundent  and  antiseptic. 
Placed  in  root-canals,  it  acts  in  the  latter  capacity, 
and  facilitates  the  introduction  of  gutta-percha 
cones,  of  which  it  is  a  solvent. 

Oil  Cloves  (Caryophylli).  Used  to  relieve  the 
pains  of  pid])itis;  in  ]iaste,  with  zinc  oxid,  as  a  pul])- 
capping.  Its  antiseptic  principle,  eugenol,  is  used 
as  a  canal-dressing  in  septic  cases. 

Oil  Cinnamon.    Powerfully  antiseptic,  and  an  ob- 


DENTAL    PATHOLOGY    AND    THERAPEUTICS.     I37 

ttindent.  Used  as  a  canal-dressing  in  septic  canals, 
it  diffuses  rapidly  through  the  dentine.  It  has 
largely  displaced  other  essential  oils  in  dentistry. 

Penta.l.  A  general  anesthetic;  used  as  a  local 
anesthetic  after  the  same  method  as  ethyl  chlorid. 

Peroxid  of  Hydrogen,  H2O2.  An  antiseptic.  In 
the  presence  of  decomposing  organic  matter,  nas- 
cent oxygen  is  liberated,  which  acts  as  a  powerful 
germicide,  antiseptic,  and  disinfectant. 

Pyrozone.  Solutions  of  hydrogen  peroxid,  3  per 
cent,  in  water,  5  per  cent,  in  ether,  25  per  cent,  in 
ether  (caustic  pyrozone).  The  latter  is  largely  em- 
ployed as  a  germicide  and  as  a  bleacher  of  discol- 
ored dentine. 

Potassium  and  Sodium.  An  alloy  of  these  metals 
is  used  to  introduce  into  purulent  pulps.  Sodium 
and  potassium  hydrates  are  immediately  formed, 
which  chemically  destroy  all  organic  matter  present. 

Potassium  Bromid.  A  general  sedative,  used 
particularly  in  excitement  due  to  cerebral  conges- 
tion. Used  as  a  rectal  injection,  gr.  v-x  in 
starch,  for  cases  of  convulsions  in  teething  children. 
It  is  usual  in  these  cases  to  combine  with  it  gr.  iij 
of  chloral  hydrate. 

Potassium  Chlorate.  Used  in  solution  or  pow- 
der in  cases  of  stomatitis,  tonsillitis,  etc. 

Potassium  lodid.  Used  in  massive  doses  where 
evidences  of  tertiary  syphilis  are  present.  In  oint- 
ment— 

Potassium  iodid,  gr.  xx; 
Cerate  simp.,  3j. — M. 

it  is  used  to  rub  over  indurations. 
>9 


138    DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

Potassium  Permanganate.  A  powerful  oxidizing 
antiseptic;  a  most  efficient  deodorant.  Fresli 
claret-colored  solutions  are  to  be  emplo3^ed. 

Sodium  Peroxid,  Na^O..  An  invaluable  agent 
in  the  treatment  of  septic  root-canals  which  contain 
the  body  or  remnants  of  the  decomposing  pulp. 
May  be  used  dry  or  in  solution. 

Thymol.  A  derivative  of  the  oil  of  thyme.  A 
very  powerful,  persistent,  and  penetrating  anti- 
septic ;  used  as  a  canal-dressing,  and  as  an  obtun- 
dent and  antiseptic  applied  to  the  dental  pulp  at  any 
stage  or  grade  of  irritation  or  inflammation. 

Tropacocain.  A  local  anesthetic  of  equal  or 
greater  power  than  cocain,  without  its  dangers. 

■  Zinc  Chlorid.  Deliquesced,  it  is  used  as  an  ob- 
tundent of  persistentl}'  hypersensitive  dentine.  Di- 
luted, it  is  the  fluid  of  oxychlorid  of  zinc  cement. 
In  solutions  4-10  grs. — oz.  j,  it  is  an  antiseptic, 
astringent,  and  stimulating  injection. 

Zinc  lodid.  In  20  per  cent,  solution  it  is  an  anti- 
septic and  astringent  application  to  pyorrhea 
pockets. 

Zinc  Sulfate.  In  saturated  solution  it  is  mixed 
with  zinc  oxid  to  form  zinc  oxvsulfate,  a  pulp- 
capping  cement. 


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Qompend  of  dental  pathology. 


389 
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